temmuz- ağustos eylül 2013 seçilmiş yayın...
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Temmuz- Ağustos- Eylül 2013 Seçilmiş Yayın Taraması
Pubmed taramasında son 3 ayda Endokrin cerrahisi ile ilgili makaleler
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Reuters verileri ile son iki yıla ait “impact factor” değerlerine göre yüksekten
düşüğe sıralanmıştır.
Derleme Prospektif
Makaleler
Retrospektif
Makaleler
Vaka
sunumu/vaka
kontrol
Tiroid 8 8 28 3
Paratiroid 1 5 8 2
Adrenal 5 13 2
NET 8 1 11
TİROİD (1841 makale taranmıştır)
DERLEME
1. Primary thyroid lymphoma: a clinical review. ►
2. Current Understanding and Management of Medullary Thyroid Cancer. ►
3. Molecular diagnosis for indeterminate thyroid nodules on fine needle aspiration:
advances and limitations. ►
4. Thyroglobulin in the washout fluid of lymph node biopsy: what is its role in the
follow-up of differentiated thyroidcarcinoma? ►
5. Therapeutic strategy for low-risk thyroid cancer in Kanaji Thyroid Hospital
[Review]. ►
6. Thyroid Storm: An Updated Review. ►
7. Anaplastic thyroid cancer in young patients: A contemporary review. ►
8. Screening for thyroid disease in pregnancy: a review. ►
TİROİD
PROSPEKTİF
1. Comparıson of elastographıc straın ındex and thyroıd fıne-needle aspıratıon
cytology ın 631 thyroıd nodules. ►
2. SPECT/CT sentinel lymph node identification in papillary thyroid cancer: lymphatic
staging and surgical management improvement. ►
3. Prospective screening in familial nonmedullary thyroid cancer. ►
4. A simplified economic approach to thyroid FNA cytology and surgical intervention
in thyroid nodules. ►
5. Quality of life after thyroid surgery in women with benign euthyroid goiter:
influencing factors including Hashimoto's thyroiditis. ►
6. Utility of diffusion-weighted imaging in differentiating malignant from benign thyroid
nodules with magnetic resonance imaging and pathologic correlation. ►
7. Sutureless thyroidectomy with energy-based devices: Cerrahpasa experience. ►
8. Comparison of measured and calculated dose rates near nuclear medicine
patients. ►
TİROİD
RETROSPEKTİF
1. Does BRAF V600E Mutation Predict Aggressive Features in
Papillary Thyroid Cancer? Results From Four Endocrine Surgery Centers. ►
2. Thyroid nodules with initially nondiagnostic cytologic results: the role of core-
needle biopsy. ►
3. Napsin A expression in anaplastic, poorly differentiated, and micropapillary pattern
thyroid carcinomas. ►
4. The biopsy-proven benign thyroid nodule: is long-term follow-up necessary? ►
5. High-Risk Patients with Differentiated Thyroid Cancer T4 Primary Tumors Achieve
Remnant Ablation Equally Well Using rhTSH or Thyroid Hormone Withdrawal. ►
6. Impact of early vs late postoperative radioiodine remnant ablation on final outcome
in patients with low-risk well-differentiated thyroid cancer. ►
7. Are prognostıc scorıng systems of value ın patıents wıth
follıcular thyroıd carcınoma? ►
8. Post-surgical thyroid ablation with low or high radioiodine activities results in
similar outcomes in intermediate risk differentiated thyroid cancer patients. ►
9. Impaired glucose metabolism is a risk factor for increased thyroid volume and
nodule prevalence in a mild-to-moderate iodine deficient area. ►
10. Total thyroidectomy for Graves' disease: Compliance with
American Thyroid Association guidelines may not always be necessary. ►
11. Clinical significance of microscopic anaplastic focus in papillary thyroid carcinoma.
►
12. Hurthle cell carcinoma: An update on survival over the last 35 years. ►
13. Clinical Significance of Delphian Lymph Node Metastasis in
Papillary Thyroid Carcinoma. ►
14. Evaluating the Morbidity and Efficacy of Reoperative Surgery in the Central
Compartment for Persistent/Recurrent Papillary Thyroid Carcinoma. ►
15. Surgery for Graves' disease: a 25-year perspective. ►
16. Ultrasound-guided fine-needle aspiration for solid thyroid nodules larger than
10 mm: correlation between sonographic characteristics at the needle tip and
nondiagnostic results. ►
17. Overexpression of miR-10a and miR-375 and downregulation of YAP1 in
medullary thyroid carcinoma. ►
18. Selective lateral compartment neck dissection for thyroid cancer. ►
19. Hürthle cell presence alters the distribution and outcome of categories in the
Bethesda system for reportingthyroid cytopathology. ►
20. Predictive factors of malignancy in patients with cytologically suspicious for Hurthle
cell neoplasm of thyroidnodules. ►
21. Superior mediastinal dissection for papillary thyroid carcinoma: approaches and
outcomes. ►
22. Neural monitored revision thyroid cancer surgery: surgical safety and thyroglobulin
response. ►
23. Prevalence and prediction for malignancy of additional thyroid nodules coexisting
with proven papillary thyroid microcarcinoma. ►
24. Electrophysiologic Monitoring Characteristics of the Recurrent Laryngeal Nerve
Preoperatively Paralyzed or Invaded with Malignancy. ►
25. Clinical characteristics of papillary thyroid microcarcinoma less than or equal to
5 mm on ultrasonography. ►
26. The role of nerve monitoring to predict postoperative recurrent laryngeal nerve
function in thyroid and parathyroid surgery. ►
27. Follicular lesion of undetermined significance in thyroid FNA revisited. ►
28. Thyroid hormone replacement therapy, surveillance ultrasonography, and fine-
needle aspiration after hemithyroidectomy. ►
TİROİD
Vaka sunumu / Vaka kontrol
1. The relationship between extent of thyroid cancer surgery and use of radioactive
iodine. ►
2. Patients' experiences following local-regional recurrence of thyroid cancer: a
qualitative study. ►
3. Pretibial myxedema without ophthalmopathy: an initial presentation of Graves'
disease. ►
PARATİROİD (465 makale taranmıştır)
DERLEME
1. Surgeon-performed ultrasound for primary hyperparathyroidism. ►
PARATİROİD
PROSPEKTİF
1. Parathyroidectomy improves symptomatology and quality of life in patients with
secondary hyperparathyroidism. ►
2. Intact parathyroid hormone measurement at 24 hours after thyroid surgery as
predictor of parathyroid function at long term. ►
3. Three-phase parathyroid 4-dimensional computed tomography initial experience:
inexperienced readers have high accuracy and high interobserver agreement. ►
4. A comparison of minimally invasive video-assisted parathyroidectomy and
traditional parathyroidectomy forparathyroid adenoma. ►
5. Genetic and epigenetic changes in sporadic endocrine
tumors: Parathyroid tumors. ►
PARATİROİD
RETROSPEKTİF
1. Causes of Emergency Department Visits Following Thyroid
and Parathyroid Surgery. ►
2. Do giant parathyroid adenomas represent a distinct clinical entity? ►
3. Efficacy of localization studies and intraoperative parathormone monitoring in the
surgical management of hyperfunctioning ectopic parathyroid glands. ►
4. Utility of intraoperative parathyroid hormone monitoring in patients with multiple
endocrine neoplasia type 1-associated primary hyperparathyroidism undergoing
initial parathyroidectomy. ►
5. Minimally Invasive Resection for Mediastinal Ectopic Parathyroid Glands. ►
6. Factors that influence parathyroid hormone half-life: determining if new
intraoperative criteria are needed. ►
7. Intraoperative parathyroid hormone assay during focused parathyroidectomy: the
importance of 20 minutes measurement. ►
8. Minimally invasive parathyroidectomy provides a conservative surgical option for
multiple endocrine neoplasia type 1-primary hyperparathyroidism. ►
PARATİROİD
VAKA SUNUMU
1. Intrathyroidal parathyroid carcinoma mimicking a thyroid nodule in a MEN type 1
patient. ►
2. Uncommon presentations of parathyroid adenoma. ►
ADRENAL (1127 makale taranmıştır)
DERLEME
1. Robotic Versus Laparoscopic Adrenalectomy: A Systematic Review and Meta-
analysis. ►
2. Familial pheochromocytomas and paragangliomas. ►
3. Adrenal schwannoma: a rare type of adrenal incidentaloma. ►
4. Adrenal masses: contemporary imaging characterization. ►
5. Pheochromocytoma - review and biochemical workup. ►
ADRENAL
RETROSPEKTİF
1. The Characterization of Pheochromocytoma and Its Impact on Overall Survival in
Multiple Endocrine Neoplasia Type 2. ►
2. Adrenal cortical adenoma: the fourth component of the Carney triad and an
association with subclinical Cushing syndrome. ►
3. Long-Term Survival After Adrenalectomy for Stage I/II Adrenocortical Carcinoma
(ACC): A Retrospective Comparative Cohort Study of Laparoscopic Versus Open
Approach. ►
4. Discriminating Pheochromocytomas from Other Adrenal Lesions: The Dilemma of
Elevated Catecholamines. ►
5. Robotic Versus Laparoscopic Adrenalectomy for Pheochromocytoma. ►
6. Surgery for adrenocortical carcinoma in The Netherlands: analysis of the national
cancer registry data. ►
7. Mutational analyses of epidermal growth factor receptor and downstream
pathways in adrenocortical carcinoma. ►
8. Can established CT attenuation and washout criteria for adrenal adenoma
accurately exclude pheochromocytoma? ►
9. Retroperitoneal Laparoendoscopic single-site adrenalectomy for
pheochromocytoma: our single centre experiences. ►
10. Perioperative, Functional, and Oncologic Outcomes of Partial Adrenalectomy for
Multiple Ipsilateral Pheochromocytomas. ►
11. Distinguishing adrenal adenomas from non-adenomas on dynamic enhanced CT:
a comparison of 5 and 10 min delays after intravenous contrast medium injection.
►
12. Laparoendoscopic Single-Site Retroperitoneoscopic Adrenalectomy versus
Conventional Retroperitoneoscopic Adrenalectomy: Initial Experience by the
Same Laparoscopic Surgeon. ►
13. Laparoscopic Adrenalectomy for Cushing's Syndrome: a 12-year experience. ►
ADRENAL
VAKA SUNUMU
1. A rare adolescent case of female pseudohermaphroditism with adrenocortical
carcinoma and synchronous teratoma. ►
2. Giant adrenal cavernous hemangioma: a rare abdominal mass. ►
NET (404 makale taranmıştır)
DERLEME
1. Gastrointestinal stromal tumour. ►
2. Current understanding of the molecular biology of pancreatic neuroendocrine
tumors. ►
3. PI3K/Akt/mTOR pathway inhibitors in the therapy of pancreatic neuroendocrine
tumors. ►
4. Gastroenteropancreatic endocrine tumors. ►
5. Advancements in pancreatic neuroendocrine tumors. ►
6. Systemic Treatment of Gastroenteropancreatic Neuroendocrine Tumors (GEP-
NETs): Current Approaches and Future Options. ►
NET
PROSPEKTİF
1. Safety, tolerability, pharmacokinetics, and pharmacodynamics of a long-acting
release (LAR) formulation of pasireotide (SOM230) in patients with
gastroenteropancreatic neuroendocrine tumors: results from a randomized,
multicenter, open-label, phase I study. ►
NET
RETROSPEKTİF
1. Revised Staging Classification Improves Outcome Prediction for Small
Intestinal Neuroendocrine Tumors. ►
2. Gastrointestinal carcinoid: epidemiological and survival evidence from a large
population-based study (n = 25 531). ►
3. High sensitivity of diffusion-weighted MR imaging for the detection of liver
metastases from neuroendocrine tumors: comparison with T2-weighted and
dynamic gadolinium-enhanced MR imaging. ►
4. Clinicopathologic characteristics of pancreatic neuroendocrine tumors and relation
of somatostatin receptor type 2A to outcomes. ►
5. Neuroendocrine carcinoma of the stomach: morphologic and
immunohistochemical characteristics and prognosis. ►
6. Clinical significance of surgery for gastric submucosal tumours with size
enlargement during watchful waiting period. ►
7. Clinical and Prognostic Features of Rectal Neuroendocrine Tumors. ►
8. Epithelial-mesenchymal transition markers in the differential diagnosis of
gastroenteropancreatic neuroendocrine tumors. ►
9. Serum pancreastatin: the next predictive neuroendocrine tumor marker. ►
10. Factors predictive of adverse events associated with endoscopic ultrasound-
guided fine needle aspiration of pancreatic solid lesions. ►
11. Short-term outcomes and cost of care of treatment of head and neck
paragangliomas. ►
TİROİD
DERLEME
1. J Clin Endocrinol Metab. 2013 Aug;98(8):3131-8. doi: 10.1210/jc.2013-1428. Epub 2013 May 28.
IF: 7.02
Primary thyroid lymphoma: a clinical review.
Stein SA, Wartofsky L.
Source
Endocrinology Division, Department of Medicine, University of Maryland School of Medicine, Baltimore,
Maryland 21201, USA.
Abstract
CONTEXT:
Although primary thyroid lymphoma is a rare cause of both thyroid malignancy and extranodal lymphoma,
awareness of this disease is important in order to achieve an early diagnosis and implement treatment. We
review the epidemiology, clinical presentation, diagnosis, and treatment of this rare disorder.
EVIDENCE ACQUISITION:
This review is based on a search of PubMed and MDConsult for English language articles containing the
term "primarythyroid lymphoma." The authors reviewed original and review articles and case series from all
years of publication but focused on those published within the last 5 years.
EVIDENCE SYNTHESIS:
Primary thyroid lymphoma should be suspected in patients with a rapidly enlarging neck mass, especially in
women with Hashimoto's thyroiditis. Certain ultrasound features such as enhanced posterior echoes can
suggest the diagnosis, but biopsy for confirmation is ultimately needed. With advances in
immunophenotypic analysis, fine-needle aspiration can be used for diagnosis in the hands of experienced
physicians. The most common type of primary thyroid lymphoma is diffuse large B-cell lymphoma, which
behaves in a more aggressive manner than mucosa-associated lymphoid tissue lymphoma. Radiation
therapy can be employed for treatment of localized mucosa-associated lymphoid tissue lymphoma, but a
combination of chemotherapy and radiation is needed for disseminated disease or aggressive histological
subtypes.
CONCLUSIONS:
It is important to consider the diagnosis of primary thyroid lymphoma in patients presenting with an
enlarging neck mass and a history of Hashimoto's thyroiditis. Advances in both diagnosis and treatment in
recent years have altered our approach to the management of this disease.
PMID: 23714679
http://dx.doi.org/10.1210/jc.2013-1428
2. Oncologist. 2013 Sep 13. [Epub ahead of print] IF: 4.62
Current Understanding and Management of Medullary Thyroid Cancer.
Roy M, Chen H, Sippel RS.
Source
Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA.
Abstract
Medullary thyroid cancer (MTC) typically accounts for 3%-4% of all thyroid cancers. Although the majority
of MTCs are sporadic, 20% of cases are hereditary. Hereditary MTC can be found in multiple endocrine
neoplasia 2A or 2B or as part of familial MTC based on a specific germline mutation in the RET: proto-
oncogene. This article discusses the current approaches available for the diagnosis, evaluation, and
management of patients and their family members with suspected MTC. The disease is predominantly
managed surgically and typically requires a total thyroidectomy and lymph node dissection. A review of
recent guidelines on the extent and timing of surgical excision is discussed. There are not very many
effective systemic treatment options for MTC, but several emerging therapeutic targets have promise.
KEYWORDS:
Familial Medullary Thyroid Cancer (FMTC), Medullary Thyroid Cancer (MTC), Multiple Endocrine Neoplasia Syndrome, Prophylactic surgery in MTC, RET proto-oncogene, Serum calcitonin
PMID: 24037980
3. Expert Rev Mol Diagn. 2013 Jul;13(6):613-23. doi: 10.1586/14737159.2013.811893. IF: 4.49
Molecular diagnosis for indeterminate thyroid nodules on fine needle aspiration: advances and limitations.
Keutgen XM, Filicori F, Fahey TJ 3rd.
Source
Department of Surgery, Division of Endocrine Surgery, New York Presbyterian Hospital - Weill Cornell
Medical Center, New York, NY 10021, USA. [email protected]
Abstract
Indeterminate thyroid lesions are diagnosed in up to 30% of fine needle aspirations. These nodules harbor
malignancy in more than 25% of cases, and hemithyroidectomy or total thyroidectomy has therefore been
advocated in order to achieve definitive diagnosis. Recently, many molecular markers have been
investigated in an attempt to increase diagnostic accuracy of indeterminate fine needle aspiration cytology
and thereby avoid unnecessary complications and costs associated with thyroid surgery. Somatic mutation
testing, mRNA gene expression platforms, protein immunocytochemistry and miRNA panels have improved
the diagnostic accuracy of indeterminate thyroid nodules, and although no test is perfectly accurate, in the
authors' opinion, these methods will most certainly become an important part of the diagnostic tools for
clinicians and cytopathologists in the future.
PMID: 23895130
http://dx.doi.org/10.1586/14737159.2013.811893
4. Thyroid. 2013 Sep 17. [Epub ahead of print] IF: 3.54
Thyroglobulin in the washout fluid of lymph node biopsy: what is its role in the follow-up of differentiated thyroidcarcinoma?
Torres MR, Nóbrega Neto SH, Rosas RJ, Martins AL, Ramos AL, da Cruz TR.
Source
Federal University of Campina Grande, Department of Endocrinology and Diabetes, Paraíba, Campina
Grande, Brazil ; [email protected].
Abstract
Background: The clinical evaluation of enlarged local lymph nodes (LNs) is difficult at the beginning and
throughout the follow-up of differentiatedthyroid carcinoma (DTC). Although the examination of samples
collected from LNs by fine-needle aspiration biopsy cytology (FNAB-C) is extremely specific for the
diagnosis of metastases, its sensitivity is low, especially in paucicellular samples. Abstract: Measurement
of thyroglobulin (Tg) in the FNAB washout fluid (FNAB-Tg) increases the diagnostic performance of
cytology to up to 100% sensitivity and specificity. However, the application of FNAB is currently hindered by
the absence of methodological standardization, a lack of definite cutoff points, and the ongoing debate
regarding its accuracy in non-thyroidectomized patients, those with elevated serum Tg, and those with
circulating anti-Tg antibodies. Conclusion: FNAB-Tg improves the diagnostic performance of FNAB-C in LN
metastases, even when the latter is unable to diagnose the metastases. For that reason, FNAB-Tg must be
included in the monitoring of DTC.
PMID: 24044517
5. Endocr J. 2013 Sep 25. [Epub ahead of print] IF: 2.23
Therapeutic strategy for low-risk thyroid cancer in Kanaji Thyroid Hospital [Review].
Kammori M, Fukumori T, Sugishita Y, Hoshi M, Yamada T.
Source
Department of Surgery, Kanaji Thyroid Hospital, Tokyo 114-0015, Japan.
Abstract
It is well-known that differentiated thyroid carcinoma (DTC) has a generally indolent character and shows a
favorable prognosis in comparison with many other carcinomas. The therapeutic strategy for patients with
DTC in Japan has differed from that in Western countries. Total thyroidectomy followed by radioactive
iodine (RAI) ablation has been standard in Western countries, whereas limited hemi-thyroidectomy and
subtotal thyroidectomy has been extensively accepted in Japan. Papillary thyroid carcinoma (PTC)
accounts for over 90% of all thyroid cancers in Japan. The majority of patients with PTC are categorized
into a low-risk group on the basis of the recent risk-group classification schemes, and they show excellent
outcomes. Several management guidelines for thyroid cancers have been published in Western countries.
However, the optimal therapeutic options for PTC remain controversial, and high-level clinical evidence
aimed at resolving these issues is lacking. Moreover, as socioeconomic differences in medical care exist,
conventional policies for the treatment of PTC have differed between Japan and other countries. This
review focuses on the special features of treatment in Japan for patients with low-risk DTC involving
subtotal thyroidectomy without adjuvant therapies, rather than total thyroidectomy with RAI, with the aim of
preserving quality of life. At our institution in Japan, we have had extensive experience with RAI treatment
for high-risk DTC patients, and this represents a very rare situation. Here we introduce the therapeutic
strategy for low-risk thyroid cancer in Japan, including the measures adopted at our institution.
PMID: 24067543
6. J Intensive Care Med. 2013 Aug 5. [Epub ahead of print] IF: 2.08
Thyroid Storm: An Updated Review. Chiha M, Samarasinghe S, Kabaker AS.
Source
Division of Endocrinology and Metabolism, Department of Medicine, Loyola University Medical Center,
Maywood, IL, USA.
Abstract
Thyroid storm, an endocrine emergency first described in 1926, remains a diagnostic and therapeutic
challenge. No laboratory abnormalities are specific to thyroid storm, and the available scoring system is
based on the clinical criteria. The exact mechanisms underlying the development ofthyroid storm from
uncomplicated hyperthyroidism are not well understood. A heightened response to thyroid hormone is often
incriminated along with increased or abrupt availability of free hormones. Patients exhibit exaggerated
signs and symptoms of hyperthyroidism and varying degrees of organ decompensation. Treatment should
be initiated promptly targeting all steps of thyroid hormone formation, release, and action. Patients who fail
medical therapy should be treated with therapeutic plasma exchange or thyroidectomy. The mortality
of thyroid storm is currently reported at 10%. Patients who have survived thyroid storm should receive
definite therapy for their underlying hyperthyroidism to avoid any recurrence of this potentially fatal
condition.
KEYWORDS:
hyperthyroidism, therapeutic plasma exchange, thyroid crisis, thyroid storm, thyrotoxicosis
PMID: 23920160
7. Am J Otolaryngol. 2013 Aug 28. pii: S0196-0709(13)00164-6. doi: 0.1016/j.amjoto.2013.07.008.
[Epub ahead of print] IF: 1.25
Anaplastic thyroid cancer in young patients: A contemporary review.
Li M, Milas M, Nasr C, Brainard JA, Khan MJ, Burkey BB, Scharpf J.
Source
Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH.
Abstract
PURPOSE:
Little is known about prognostic factors and treatment outcomes in young patients with
anaplastic thyroid cancer (ATC). The goal of this study is to define the clinical features of this subgroup.
MATERIAL AND METHODS:
Patients age 55 or younger with either ATC or well-differentiated thyroid cancer (WDTC) with anaplastic
changes were identified using electronic medical record at the Cleveland Clinic. The same number of
patients older than 55 was randomly selected to serve as control. Progression-free survival (PFS), overall
survival time (OST) and cause-specific mortality (CSM) were measured against age, tumor histology,
extent of disease, and treatment modalities.
RESULTS:
Twelve patients age 55 or younger were identified. The median age was 51years. Four patients had WDTC
with anaplastic components - mixed tumor group (MTG). Their median PFS, OST, and CSM at 24months
were 21.5months, 51months, and 25%, respectively. For the other 8 patients who had pure ATC, their
median PFS, OST, and CSM were 3.5months, 6months, and 100%, respectively. Patients in the MTG had
better survival compared to the pure ATC and control group in terms of PFS (p=0.0047 and p=0.0053),
OST (p=0.0028 and p=0.0029) and the CSM at 24months (p=0.0339 and p=0.0096). In the pure ATC
group, patients with positive cervical lymph node and distant metastases had similar overall survival
outcomes (6 vs. 8months, p=0.4995).
CONCLUSION:
Prognostic factors favoring survival in young patients with ATC include ATC arising within WDTC. Once full
anaplastic transformation occurs, age was not a significant factor in survival.
© 2013.
PMID: 23993450
http://dx.doi.org/0.1016/j.amjoto.2013.07.008
8. Minerva Ginecol. 2013 Aug;65(4):471-84. IF: 0.90
Screening for thyroid disease in pregnancy: a review.
Cassar NJ, Grima AP, Ellul GJ, Schembri-Wismayer P, Calleja-Agius J.
Source
Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Tal-Qroqq, Msida MSD,
Malta - [email protected].
Abstract
Screening for thyroid disease in pregnancy remains a contentious issue. This review presents these
diverging views and discusses their reasons as well as the relevant facts. The final aim is to establish the
information gaps and limitations - technological or otherwise - which still need to be eliminated in order to
settle the debate conclusively. The prevalence of the more common thyroid dysfunctions that occur in and
after pregnancy is discussed. The subsequent impact of these disorders on mother and offspring is also
described. Special focus is placed on the benefits and setbacks of currently available and newly proposed
investigations, which assay serum hormone levels, serum autoantibody levels, and/or use clinical data. It is
pointed out that the relevance of screening varies from one region of the world to the other, based on the
content of iodine and selenium in food and water. The review then discusses the current major arguments
for and against screening, as well as recommendations and proposed alternatives.
PMID: 24051947
TİROİD
PROSPEKTİF
1. J Clin Endocrinol Metab. 2013 Sep 24. [Epub ahead of print] IF: 7.02
COMPARISON OF ELASTOGRAPHIC STRAIN INDEX AND THYROID FINE-NEEDLE ASPIRATION CYTOLOGY IN 631 THYROID NODULES.
Magri F, Chytiris S, Capelli V, Gaiti M, Zerbini F, Carrara R, Malovini A, Rotondi M, Bellazzi R, Chiovato L.
Source
Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri IRCCS; University of Pavia,
Pavia, Italy (F.M., SC, V.C., M.G., F.Z., R.C., M.R., L.C.); and Laboratorio di Informatica e Sistemistica per
la Ricerca Clinica, IRCCS Fondazione S.Maugeri, Pavia (A.M., R.B.).
Abstract
Context:Ultrasound (US) elastography (USE) was recently reported as a sensitive, non-invasive tool for
identifying thyroid cancer. However, the accuracy of this technique is hampered by the intra- and inter-
operator variability, some US features of the nodule and by the coexistence of autoimmune thyroid disease
(ATD).Objectives:to assess the accuracy of USE in the differential diagnosis of thyroid nodules as
compared with other US features, to evaluate its feasibility in the presence of ATD, to identify the strain
index (SI) cut-off with the highest diagnostic performance.Design:528 consecutive patients for a total of
661 thyroid nodules were evaluated. All nodules underwent fine-needle aspiration cytology (FNAC) and
USE evaluation. The SI was calculated as a ratio of the nodule strain divided by the strain of the softest
part of the surrounding normal tissue.Results:The median SI value was significantly higher in THY4 and
THY5 than in THY2 nodules in ATD-positive, ATD-negative and ATD-unknown patients. The cut-off of SI
for malignancy was estimated at 2.905 by ROC curve analysis in a screening set (379 FNAC results), and
then tested in a replication set (252 FNAC results). In all cases, a SI ≥ 2.905 conferred to the nodule a
significantly greater probability of being malignant. This SI cut-off had the greatest AUC, sensitivity and
NPV, compared to the conventional US features of malignancy.Conclusion:The elastographic SI has a high
sensitivity, specificity and negative predictive value for the diagnosis of thyroid malignancy both in the
presence and in the absence of ATD. If our data on USE will be confirmed also in THY3 nodules, FNAC
could be avoided in a consistent number of thyroid nodules.
PMID: 24064692
2. Eur J Nucl Med Mol Imaging. 2013 Aug 2. [Epub ahead of print] IF: 4.82
SPECT/CT sentinel lymph node identification in papillary thyroid cancer: lymphatic staging and surgical management improvement.
Garcia-Burillo A, Roca Bielsa I, Gonzalez O, Zafon C, Sabate M, Castellvi J, Serres X, Iglesias C, Vilallonga R, Caubet E, Fort JM, Mesa J, Armengol M, Castell-Conesa J.
Source
Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain,
Abstract
PURPOSE:
Lymphadenectomy in papillary thyroid carcinoma (PTC) continues to be controversial. A better staging
method is needed to provide adequate individual surgical treatment. SPECT/CT lymphoscintigraphy and
sentinel lymph node (SLN) biopsy may improve lymphatic staging and surgical treatment. Our main
objectives were to describe the lymphatic drainage of PTC using lymphoscintigraphy, to evaluate the
lymphatic spread (comparing SLN and lymphadenectomy results) and to analyse the impact of SLN
identification in surgery.
METHODS:
We prospectively studied 24 consecutive patients with PTC (19 women; mean age 52.7 years, range 22-
81 years). The day before surgery, lymphoscintigraphy with ultrasound-guided intratumoral injection (99mTc-
nanocolloid, 148 MBq) was performed, obtaining planar and SPECT/CT images. All patients underwent
total thyroidectomy, SLN biopsy (hand-held gamma probe) with perioperative analysis, central
compartment node dissection, or laterocervical lymphadenectomy if perioperative stage N1b or positive
SLNs in this lymphatic basin.
RESULTS:
Lymphoscintigraphy revealed at least one SLN in 19 of 24 patients (79 %) on planar and SPECT/CT
images, and in 23 of 24 patients (96 %) during surgery using a hand-held gamma probe. Lymph node
metastases were detected with classical perioperative techniques (ultrasound guidance and surgical
inspection) in 3 of 24 patients, by perioperative SLN analysis in 10 of 23, and by definitive histology in 13 of
24. The false-negative (FN) ratio for SLN was 7.7 % (one patient with bulky lymph nodes). The FN ratio for
perioperative frozen sections was 15.4 % (two patients, one with micrometastases, the other with bilateral
SLN). Lymphatic drainage was only to the central compartment in 6 of 24 patients (3 of the 6 with positive
SLNs for metastases), only to the laterocervical basin in 5 of 24 patients (all unilateral, 2 of 5 positive
SLNs) and to the central and laterocervical compartments in 12 of 24 patients (6 of 12 and 3 of 12 positive
SLNs, respectively).
CONCLUSION:
Lymphoscintigraphy reveals the lymph node drainage in a high proportion of patients. It detects
laterocervical drainage in a significant percentage of patients, allowing the detection of occult lymph node
metastases and improving the surgical management in PTC.
PMID: 23907326
3. Surgery. 2013 Aug 23. pii: S0039-6060(13)00341-3. doi: 10.1016/j.surg.2013.06.019. [Epub ahead
of print] IF: 3.19
Prospective screening in familial nonmedullary thyroid cancer.
Sadowski SM, He M, Gesuwan K, Gulati N, Celi F, Merino MJ, Nilubol N, Kebebew E.
Source
Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Electronic address: [email protected].
Abstract
BACKGROUND:
Approximately 8% of nonmedullary thyroid cancers are familial. The optimal age for screening in familial
nonmedullary thyroid cancer (FNMTC) is unknown.
METHODS:
Kindreds with FNMTC (2 or more first-degree relatives affected) were screened prospectively
with thyroid ultrasonography.
RESULTS:
Fifteen kindreds showed an overall prevalence of thyroid nodule(s) ≥5 mm of 44% at screening; 19% in the
second generation, and 90% in the generation anterior to the index case. The youngest age of detection
was 10 years for thyroid nodules and 18 years for thyroid cancer. Microcalcification of thyroid nodules at
screening was associated with a greater risk of cancer (P < .05). Family members diagnosed
with thyroidcancer by ultrasonographic screening were diagnosed at a younger age and had a lower rate of
extra thyroidal invasion (P < .05).
CONCLUSION:
In FNMTC, first-degree relatives 10 years or older, including the generation anterior to the index case,
should have thyroid screening by ultrasonography, which may result in earlier diagnosis.
Copyright © 2013 Mosby, Inc. All rights reserved.
PMID: 23978593
http://dx.doi.org/10.1016/j.surg.2013.06.019
4. J Clin Pathol. 2013 Jul;66(7):583-8. doi: 10.1136/jclinpath-2012-201339. Epub 2013 Mar 26. IF:
2.82
A simplified economic approach to thyroid FNA cytology and surgical intervention in thyroid nodules.
Poller DN, Kandaswamy P.
Source
Department of Pathology, Queen Alexandra Hospital, Portsmouth, UK. [email protected]
Abstract
OBJECTIVE:
Few studies have modelled the economics of thyroid FNA.
METHODS:
A simple spreadsheet economic model for delivery of thyroid fine needle aspiration (FNA) cytology is
described using the UK Royal College of Pathologists' Classification for thyroid FNA which is based on The
Bethesda System for Reporting Thyroid Cytopathology.
RESULTS:
We show an estimated 27.8% cost treatment reduction per patient if low rates of non-diagnostic for
cytological diagnosis (Thy 1) and neoplasm possible atypia/non-diagnostic (Thy 3a) are achieved, which
require rapid onsite FNA adequacy assessment of aspiration samples. If we assume that the number of
thyroid FNAs performed in the UK annually is around 500 per million, and the UK population is 62 million,
this could save the UK National Health Service significant sums, as the additional cost per patient treated in
this model varies from £781 for a scenario with ultrasound guided FNA and inclinic cell adequacy
assessment to £998 where aspirates are taken in conventional fashion without any inclinic adequacy
assessment.
CONCLUSIONS:
This model makes a strong economic case for the introduction of rapid onsite assessment of thyroid FNA
across cancer networks, to improve the diagnostic efficacy of thyroid FNA.
KEYWORDS:
Cancer, Cytology, Diagnosis, Surgery, Thyroid
PMID: 23533260
http://dx.doi.org/10.1136/jclinpath-2012-201339
5. Am J Surg. 2013 Sep 23. pii: S0002-9610(13)00441-8. doi: 10.1016/j.amjsurg.2013.05.005. [Epub
ahead of print] IF: 2.39
Quality of life after thyroid surgery in women with benign euthyroid goiter: influencing factors including Hashimoto's thyroiditis.
Promberger R, Hermann M, Pallikunnel SJ, Seemann R, Meusel M, Ott J.
Source
Second Department of Surgery "Kaiserin Elisabeth", Krankenanstalt Rudolfstiftung, Vienna, Austria;
Department of Surgery, Medical University of Vienna, Vienna, Austria.
Abstract
BACKGROUND:
Hashimoto's thyroiditis is associated with decreased quality of life (QoL). Thyroid surgery could
hypothetically lead to an increase in QoL.
METHODS:
In a follow-up analysis of a prospective cohort study that included euthyroid women
undergoing thyroid surgery for benign thyroid disease, 248 patients were willing to answer the SF-36 QoL
questionnaire.
RESULTS:
At follow-up after a median of 26 months, only the SF-36 module of "bodily pain" had increased (P = .046).
Preoperative anti-thyroidperoxidase antibody levels were positively correlated with increasing QoL in the
SF-36 modules "bodily pain" (P < .001) and "role emotional" (P < .001). For the presence of histologically
confirmed Hashimoto's thyroiditis, a significant positive correlation (P < .001) was found for all modules
apart from "physical functioning."
CONCLUSIONS:
In women with benign euthyroid goiter, thyroid surgery does not lead to an overall improvement in health-
related QoL. It should not be recommended for patients with elevated anti-thyroid peroxidase antibody
levels. Patients with histologically confirmed Hashimoto's thyroiditis might benefit in terms of QoL.
Copyright © 2013 Elsevier Inc. All rights reserved.
KEYWORDS:
Anti–thyroid peroxidase antibodies, Autoimmune thyroiditis, Hashimoto's thyroiditis, Quality of life, Thyroidectomy
PMID: 24070662
http://dx.doi.org/10.1016/j.amjsurg.2013.05.005
6. J Comput Assist Tomogr. 2013 Jul-Aug;37(4):505-10. doi: 10.1097/RCT.0b013e31828d28f0. IF:
1.75
Utility of diffusion-weighted imaging in differentiating malignant from benign thyroid nodules with magnetic resonance imaging and pathologic correlation.
Shi HF, Feng Q, Qiang JW, Li RK, Wang L, Yu JP.
Source
Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Abstract
OBJECTIVE:
The objective of this study was to evaluate the role of magnetic resonance diffusion-weighted imaging
(DWI) in differentiating malignant from benign thyroid nodules.
METHODS:
The prospective study included 111 consecutive patients with solitary thyroid nodules (23 malignant and 88
benign nodules) who underwent DWI. The DWI signal and apparent diffusion coefficient (ADC) values of
the nodules were determined and correlated with the histopathologic findings.
RESULTS:
The majority (65%) of malignant thyroid nodules showed slightly hyperintense, and the majority (69%) of
benign nodules were hyperintense on DWI (P < 0.01). The ADC values were lower in the thyroid cancer
than in the adenoma and nodular goiter (P < 0.05). When the b factor was 500 s/mm, an ADC value of
1.704 × 10 mm/s can be threshold differentiating malignant from benign nodules, with 92% sensitivity, 88%
specificity, and 87% accuracy. The higher cell density and more severe desmoplastic response were the
causes of the lower ADC value of thyroid cancer.
CONCLUSION:
Diffusion-weighted imaging can be a promising noninvasive imaging to discriminate malignant from benign
nodules.
PMID: 23863524
http://dx.doi.org/10.1097/RCT.0b013e31828d28f0
7. Updates Surg. 2013 Aug 29. [Epub ahead of print] IF: 1.13
Sutureless thyroidectomy with energy-based devices: Cerrahpasa experience.
Teksoz S, Bukey Y, Ozcan M, Arikan AE, Ozyegin A.
Source
Cerrahpasa Medical Faculty, Department of General Surgery, Istanbul University, Fatih/Istanbul, 34098,
Turkey, [email protected].
Abstract
Total thyroidectomy makes up the majority of all thyroidectomy cases. Energy-based advanced vessel-
sealing devices which were developed in recent years for the control of vascular pedicles allowed
significant progress in thyroid surgery. This study is designed to compare the efficiency and safety of the
two energy-based vessel-sealing devices (Ligasure™ LF1212 and Harmonic FOCUS®) in sutureless
thyroidectomy. Two hundred and forty-five consecutive patients underwent sutureless total thyroidectomy.
Patients were randomized for the Ligasure™ LF1212 (n = 126) or Harmonic FOCUS® (n = 119). The
parameters of demographics, surgical indications, morbidity, incision length, duration of operation, weight
of specimen, amount of drainage, postoperative pain, hospital stay, and histopathology of specimen were
recorded. Mean duration of operation was 37.98 ± 14.98 min (16-92 min) and was significantly shorter for
Harmonic FOCUS® (p < 0.001). Mean hospital stay was 1.09 ± 0.3 (1-3) days. Morbidity rate was 9.8 % in
total, whereas no mortality was observed. In terms of morbidity rates, no significant difference was
determined between the two groups (p = 0.476). In both groups, there was no need for extra analgesic
application other than the routine given after surgery. According to our experience, sutureless
thyroidectomy can be performed with low morbidity rates in secure and efficient way.
PMID: 23990508
8. Health Phys. 2013 Aug;105(2):187-91. doi: 10.1097/HP.0b013e318290cc0e. IF: 0.99
Comparison of measured and calculated dose rates near nuclear medicine patients.
Yi Y, Stabin MG, McKaskle MH, Shone MD, Johnson AB.
Source
Institute of Radiation Medicine, Fudan University, No. 2094, Xietu Road, Shanghai, 200032, PR China.
Abstract
Widely used release criteria for patients receiving radiopharmaceuticals (NUREG-1556, Vol. 9, Rev.1,
Appendix U) are known to be overly conservative. The authors measured external exposure rates near
patients treated with I, Tc, and F and compared the measurements to calculated values using point and line
source models. The external exposure dose rates for 231, 11, and 52 patients scanned or treated with I,
Tc, and F, respectively, were measured at 0.3 m and 1.0 m shortly after radiopharmaceutical
administration. Calculated values were always higher than measured values and suggested the application
of "self-shielding factors," as suggested by Siegel et al. in 2002. The self-shielding factors of point and line
source models for I at 1 m were 0.60 ± 0.16 and 0.73 ± 0.20, respectively. For Tc patients, the self-
shielding factors for point and line source models were 0.44 ± 0.19 and 0.55 ± 0.23, and the values were
0.50 ± 0.09 and 0.60 ± 0.12, respectively, for F (all FDG) patients. Treating patients as unshielded point
sources of radiation is clearly inappropriate. In reality, they are volume sources, but treatment of their
exposures using a line source model with appropriate self-shielding factors produces a more realistic, but
still conservative, approach for managing patient release.
PMID: 23799503
http://dx.doi.org/10.1097/HP.0b013e318290cc0e
TİROİD
RETROSPEKTİF
1. J Clin Endocrinol Metab. 2013 Sep;98(9):3702-12. doi: 10.1210/jc.2013-1584. Epub 2013 Aug 22.
IF: 7.02
Does BRAF V600E Mutation Predict Aggressive Features in Papillary Thyroid Cancer? Results From Four Endocrine Surgery Centers.
Li C, Aragon Han P, Lee KC, Lee LC, Fox AC, Beninato T, Thiess M, Dy BM, Sebo TJ, Thompson GB, Grant CS, Giordano TJ, Gauger PG, Doherty GM, Fahey TJ 3rd, Bishop J, Eshleman JR, Umbricht CB, Schneider EB, Zeiger MA.
Source
MD,Oncology, and Cellular and Molecular Medicine, Chief of Endocrine Surgery, Johns Hopkins Hospital,
600 North Wolfe Street, Department of Surgery, Blalock 606, Baltimore, Maryland 21287.
Abstract
Background: Existing evidence is controversial regarding the association between BRAF mutation status
and aggressive features of papillary thyroidcancer (PTC). Specifically, no study has incorporated multiple
surgical practices performing routine central lymph node dissection (CLND) and thus has patients who are
truly evaluable for the presence or absence of central lymph node metastases (CLNMs). Methods:
Consecutive patients who underwent total thyroidectomy and routine CLND at 4 tertiary endocrine surgery
centers were retrospectively reviewed. Descriptive and bivariable analyses examined demographic, patient,
and tumor-related factors. Multivariable analyses examined the odds of CLNM associated with positive
BRAF status. Results: In patients with classical variant PTC, bivariate analysis found no significant
associations between BRAF mutation and aggressive clinicopathologic features; multivariate analysis
demonstrated that BRAF status was not an independent predictor of CLNM. When all patients with PTC
were analyzed, including those with aggressive or follicular subtypes, bivariate analysis showed BRAF
mutation to be associated with LNM, advanced American Joint Committee on Cancer (AJCC) stage, and
histologic subtype. Multivariable analyses showed BRAF, age, size, and extrathyroidal extension to be
associated with CLNM. Conclusion: Although BRAF mutation was found to be an independent predictor of
central LNM in the overall cohort of patients with PTC, this relationship lost significance when only classical
variant PTC was included in the analysis. The usefulness of BRAF in predicting the presence of LNM
remains questionable. Prospective studies are needed before BRAF mutation can be considered a reliable
factor to guide the treatment of patients with PTC, specifically whether to perform prophylactic CLND.
PMID: 23969188
http://dx.doi.org/10.1210/jc.2013-1584
2. Radiology. 2013 Jul;268(1):274-80. doi: 10.1148/radiol.13122247. Epub 2013 Mar 22. IF:
6.40
Thyroid nodules with initially nondiagnostic cytologic results: the role of core-needle biopsy.
Yeon JS, Baek JH, Lim HK, Ha EJ, Kim JK, Song DE, Kim TY, Lee JH.
Source
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine,
Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea.
Abstract
PURPOSE:
To evaluate the role of core-needle biopsy (CNB) in thyroid nodules with nondiagnostic results at previous
fine-needle aspiration (FNA).
MATERIALS AND METHODS:
From October 2008 to July 2011, 155 nodules from 155 patients (37 men, 118 women) with a mean age of
51.8 years (age range, 22-76 years) with nondiagnostic results at previous FNA were reviewed
retrospectively. The Bethesda system for reporting thyroid cytopathologic results was used to assign FNA
and CNB findings. Malignant nodules (n = 37) were diagnosed after surgery. Benign nodules (n = 79) were
diagnosed either after surgery, with benign findings after FNA and/or CNB that had been repeated at least
twice, or after benign cytology findings at FNA or CNB with a stable size at follow-up. The sensitivity,
specificity, positive predictive value, negative predictive value, and accuracy of ultrasonographically guided
CNB were evaluated.
RESULTS:
At CNB, two nodules (1.3%) showed nondiagnostic results, and 135 nodules (87.1%) had conclusive
diagnoses. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of
core biopsies for the detection of malignancy were 94.6% (35 of 37), 100% (79 of 79), 100% (35 of 35),
97.5% (79 of 81), and 98.3% (114 of 116), respectively. For 28 nodules, nondiagnostic results were found
after two or more FNA procedures; however, diagnostic surgery was performed in only one patient.
CONCLUSION:
CNB of the thyroid nodule demonstrates high rates of conclusive and accurate diagnoses in patients for
whom previous FNA results were nondiagnostic, thereby reducing the need for unnecessary diagnostic
surgery.
PMID: 23525204
http://dx.doi.org/10.1148/radiol.13122247
3. Am J Surg Pathol. 2013 Aug;37(8):1215-22. doi: 10.1097/PAS.0b013e318283b7b2. IF:5.53
Napsin A expression in anaplastic, poorly differentiated, and micropapillary pattern thyroid carcinomas.
Chernock RD, El-Mofty SK, Becker N, Lewis JS Jr.
Source
Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA.
Abstract
Napsin A is a sensitive and specific marker for pulmonary adenocarcinoma versus squamous cell
carcinoma. However, studies have shown that napsin A is also positive in approximately 5% of papillary
thyroid carcinomas. The prevalence of napsin A in more aggressive types of thyroid carcinoma is unknown.
Napsin A positivity in metastatic thyroid carcinoma, especially in conjunction with thyroid transcription
factor-1 (TTF-1), could be misdiagnosed as lung adenocarcinoma. We investigated napsin A, TTF-1, and
PAX8 expression in 26 anaplastic, 16 poorly differentiated, and 2 micropapillary pattern thyroid carcinomas.
A focal micropapillary component was also present in 3 poorly differentiated and 3 anaplastic thyroid
carcinomas. Four of 26 (15%) anaplastic, 2/16 (13%) poorly differentiated, and 2/2 (100%) micropapillary
pattern thyroid carcinomas were napsin A positive. Three of the 6 cases (50%) with a focal micropapillary
component were napsin A positive (1 of these 3 cases was positive only in the micropapillary component).
All napsin A-positive cases were also positive for TTF-1, and all but 1 micropapillary pattern carcinoma
were also PAX8 positive. In 1 case, napsin A was positive in the micropapillary component, but PAX8 was
only positive in the adjacent poorly differentiated carcinoma. In summary, a minority of anaplastic and
poorly differentiated thyroid carcinomas are napsin A positive. More importantly, napsin A expression is
more common in carcinomas with a micropapillary component, a pattern shared in common with some lung
adenocarcinomas. PAX8 may be diagnostically useful to distinguish these napsin A-positive thyroid
carcinomas from lung adenocarcinomas, which are PAX8 negative.
PMID: 23681073
http://dx.doi.org/10.1097/PAS.0b013e318283b7b2
4. J Am Coll Surg. 2013 Jul;217(1):81-8; discussion 88-9. doi: 10.1016/j.jamcollsurg.2013.03.014.
Epub 2013 May 6. IF: 4.11
The biopsy-proven benign thyroid nodule: is long-term follow-up necessary?
Lee S, Skelton TS, Zheng F, Schwartz KA, Perrier ND, Lee JE, Bassett RL, Ahmed S, Krishnamurthy S, Busaidy NL, Grubbs EG.
Source
Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, USA.
Abstract
BACKGROUND:
Thyroid nodules are common, and of those biopsied by fine-needle aspiration (FNA), the majority will be
benign colloid nodules (BCN). Current guidelines suggest these BCN should be followed by
ultrasonographic examination (US) every 3 years, with no endpoint specified. This study evaluated if long-
term follow-up of benign thyroid nodules was associated with change in treatment or improvement in
diagnosing a missed malignancy compared with short-term follow-up.
STUDY DESIGN:
All patients with FNA-based diagnosis of BCN at our institution from 1998 to 2009 were identified. Patients
observed after the diagnosis were divided into short-term follow-up (<3 years) and long-term follow-up (≥3
years). Rates of repeat FNA, thyroidectomy, and malignancy detection were compared.
RESULTS:
Of 738 patients with BCN, 92 patients underwent thyroid resection after the initial US. Six hundred forty-six
patients were observed, of which 366 returned for 1 or more follow-up US: 226 in the short-term group
(median 13 months) and 140 in the long-term group (median 57 months). There were more follow-up US in
long-term vs short-term (medians 4 vs 2, p < 0.01), more repeat FNAs in the long-term group (18 of 140 vs
8 of 226, p < 0.01); but no difference in interval thyroidectomies (13 of 140 vs 31 of 226, p = 0.25) or
malignant final pathology (0 of 13 vs 2 of 31, p > 0.99). For all patients undergoing surgery, pathology was
malignant in 2 of 136 (1.5%).
CONCLUSIONS:
Long-term follow-up of patients with BCN is associated with increased repeat FNA and US without
improvement in the malignancy detection rate. After 3 years of follow-up, consideration should be given to
ceasing long-term routine follow-up of biopsy-proven BCN.
Copyright © 2013 American College of Surgeons. All rights reserved.
PMID: 23659946
http://dx.doi.org/10.1016/j.jamcollsurg.2013.03.014
5. Thyroid. 2013 Sep 16. [Epub ahead of print] IF:3.84
High-Risk Patients with Differentiated Thyroid Cancer T4 Primary Tumors Achieve Remnant Ablation Equally Well Using rhTSH or Thyroid Hormone Withdrawal.
Bartenstein P, Calabuig EC, Maini C, Mazzarotto R, Muros de Fuentes MA, Petrich T, Rodrigues F, Vallejo Casas JA, Vianello F, Basso M, Balaguer MG, Haug A,Monari F, Vano RS, Sciuto R, Magner J.
Source
Klinikum der Universitat Munchen, Nuklearmedizin, Munchen, Germany ; [email protected]
muenchen.de.
Abstract
Background: Few data exist on using rhTSH with radioiodine for thyroid remnant ablation of patients who
had T4 primary tumors (invasion beyond thethyroid capsule). Methods: A retrospective chart review
protocol at nine centers in Europe was set up with special waiver of need for informed consent, and a
careful procedure to avoid selection bias when enrolling patients into the data base. Data on 144 eligible
patients with T4 tumors were collected (T4, N0-1, M0-1; mean age 49.7 years; 65% female; 88% papillary
cancer). All had received 131I remnant ablation following TSH stimulation with rhTSH or thyroid hormone
withdrawal (THW) since January, 2000 (rhTSH n = 74, THW n = 70). The primary endpoint was based on
evaluation of diagnostic radioiodine scan thyroid bed uptake > 6 months after the ablation procedure, while
stimulated serum Tg was a secondary endpoint. Safety was evaluated within 30 days after rhTSH or 131I.
Results: Successful ablation judged by scan was achieved in 65/70 (92.9%) of rhTSH and in 61/67 (91.0%)
of THW patients; the success rates were comparable since non-inferiority criteria were met. Although some
patients in the initial cohort had tumor in cervical nodes and metastases, considering all evaluable patients
regardless of various serum anti-Tg antibody assessments, the stimulated Tg was < 2 ng/mL in 48/70
(68.6%) and 39/67 (58.2%) in rhTSH and THW groups, respectively; if patients with anti-Tg antibody levels
> 30 IU/mL were excluded, the stimulated Tg was < 2 ng/mL in 42/62 (67.7%) and 37/64 (57.8%),
respectively. No serious adverse events occurred within the 30 day window after ablation. Conclusions:
Use of rhTSH as preparation for thyroid remnant ablation in patients with T4 primary tumors achieved a
rate of ablation success that was high and non-inferior to the rate seen after THW, and rhTSH was well-
tolerated.
PMID: 24040896
6. Clin Endocrinol (Oxf). 2013 Jul 29. doi: 10.1111/cen.12301. [Epub ahead of print] IF: 3.75
Impact of early vs late postoperative radioiodine remnant ablation on final outcome in patients with low-risk well-differentiated thyroid cancer.
Tsirona S, Vlassopoulou V, Tzanela M, Rondogianni P, Ioannidis G, Vassilopoulos C, Botoula E, Trivizas P, Datseris I, Tsagarakis S.
Source
Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece.
Abstract
OBJECTIVE:
Postoperative radioiodine remnant ablation (RRA) represents an adjunctive therapeutic modality in patients
with differentiated thyroidcancer (DTC). The impact of late vs early RRA on the outcome of DTC is currently
unclear. The aim of the study was to evaluate the outcome of patients with DTC according to RRA timing.
DESIGN RETROSPECTIVE STUDY PATIENTS:
A total of 107 TNM stage 1 DTC patients were divided into two groups. In group A (n = 50), RRA was
administered in less than 4·7 months median 3·0 (range 0·8-4·7), while in group B (n = 57) in more than
4·7 months median 6 (4·8-30·3) after thyroidectomy. Remission was achieved when stimulated serum Tg
levels were undetectable, in the absence of local recurrence or cervical lymph node metastases on the
neck ultrasound.
RESULTS:
All patients underwent near-total thyroidectomy. The mean age at diagnosis was 49·3 years (range: 18-
79 years). There were no statistically significant differences in the histological subtype, the TNM stage, the
dose of radioiodine and the time of follow-up, between the two groups. After the RRA treatment, 44 group A
patients (88%) were in remission and 6 (12%) in persistence; while in group B, 52 (91·2%) were in
remission, 1 (1·8%) in persistence and 4 (7%) in recurrence. At their latest follow-up median 87·3 (23·3-
251·6 months), all patients were in remission, either as a result of further iodine radioiodine therapy (in 11
patients) or watchful monitoring.
CONCLUSIONS:
The timing of RRA seems to have no effect on the long-term outcome of the disease. Therefore, urgency
for radioiodine ablation in patients with low-risk thyroid cancer is not recommended.
© 2013 John Wiley & Sons Ltd.
PMID: 23895145
http://dx.doi.org/10.1111/cen.12301
7. Eur J Endocrinol. 2013 Sep 19. [Epub ahead of print] IF: 3.64
ARE PROGNOSTIC SCORING SYSTEMS OF VALUE IN PATIENTS WITH FOLLICULAR THYROID CARCINOMA?
Rios A, Rodríguez J, Ferri B, Martinez-Barba E, Febrero B, Parrilla P.
Source
A Rios, Surgery, Hospital Universitario Virgen de la Arrixaca, Murcia, 30007, Spain.
Abstract
PURPOSE. MOST PROGNOSTIC SYSTEMS FOR DIFFERENTIATED CARCINOMA HAVE BEEN
DESIGNED FOR PAPILLARY CARCINOMA. OBJECTIVE: To analyze the value of the existing prognostic
systems to follicular carcinoma, and to determine if any of them have a better predictive effect. METHODS.
A TOTAL OF 66 FOLLICULAR CARCINOMAS WERE ANALYZED.
THE FOLLOWING PROGNOSTIC SYSTEMS WERE STUDIED:
the EORTC; AGES; AMES; MACIS; TNM and the NTCTCS systems.Results. The AGES and AMES
systems were the only ones which had not a good prognostic correlation. The EORTC system showed that
at five years, 89% of patients in group 1 were disease-free; in group 2, 75 %; in group 3, 69%; and in 4,
0%. The MACIS system showed 83%, 60%, 67% and 0%, respectively. The TNM system showed 81%,
71%, 50%, and 0%. Finally, the NTCTCS system demonstrated 100%, 84%, 53% and 0%. Cox's
regression analysis and the proportion of variation in survival time explained (PVE) were calculated. The
prognostic classification was EORTC at 67.64% of the PVE; followed by the TNM system (62.5%) and the
MACIS (57.82%).Conclusions. The MACIS and TNM systems were good prognostic systems for evaluating
follicular thyroid carcinoma, although the one with the most prognostic value was the EORTC system.
PMID: 24050927
8. Eur J Endocrinol. 2013 Jun 1;169(1):23-9. doi: 10.1530/EJE-12-0954. Print 2013 Jul. IF: 3.64
Post-surgical thyroid ablation with low or high radioiodine activities results in similar outcomes in intermediate risk differentiated thyroid cancer patients.
Castagna MG, Cevenini G, Theodoropoulou A, Maino F, Memmo S, Claudia C, Belardini V, Brianzoni E, Pacini F.
Source
Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism
and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci 1, 53100 Siena,
Italy.
Abstract
BACKGROUND:
In differentiated thyroid cancer (DTC) patients at intermediate risk of recurrences, no evidences are
provided regarding the optimal radioactive iodine (RAI) activity to be administered for post-surgical thyroid
ablation.
METHODS:
This study aimed to evaluate the impact of RAI activities on the outcome of 225 DTC patients classified as
intermediate risk, treated with low (1110-1850 MBq) or high RAI activities (≥3700 MBq).
RESULTS:
Six to 18 months after ablation, remission was observed in 60.0% of patients treated with low and in 60.0%
of those treated with high RAI activities, biochemical disease was found in 18.8% of patients treated with
low and in 14.3% of patients treated with high RAI activities, metastatic disease was found in 21.2% of
patients treated with low and in 25.7% of patients treated with high RAI activities (P=0.56). At the last
follow-up (low activities, median 4.2 years; high activities, median 6.9 years), remission was observed in
76.5% of patients treated with low and in 72.1% of patients treated with high RAI activities, persistent
disease was observed in 18.8% of patients treated with low and in 23.5% of patients treated with high RAI
activities, recurrent disease was 2.4% in patients treated with low and 2.1% in patients treated with high
RAI activities, deaths occurred in 2.4% of patients treated with low and in 2.1% of patients treated with high
RAI activities (P=0.87).
CONCLUSION:
Our study provides the first evidence that in DTC patients at intermediate risk, high RAI activities at ablation
have no major advantage over low activities.
PMID: 23594687
http://dx.doi.org/10.1530/EJE-12-0954
9. Metabolism. 2013 Jul;62(7):970-5. doi: 10.1016/j.metabol.2013.01.009. Epub 2013 Feb 5. IF:
3.23
Impaired glucose metabolism is a risk factor for increased thyroid volume and nodule prevalence in a mild-to-moderate iodine deficient area.
Anil C, Akkurt A, Ayturk S, Kut A, Gursoy A.
Source
Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Ankara, Turkey.
Abstract
OBJECTIVE:
Insulin resistance (IR) is a key factor involved in the pathogenesis of impaired glucose metabolism. IR is
associated with increased thyroid volume and nodule prevalence in patients with metabolic syndrome. Data
on the association of thyroid morphology and abnormal glucose metabolism are limited. This prospective
study was carried out to evaluate thyroid volume and nodule prevalence in patients with pre-diabetes and
type 2 diabetes mellitus (DM) in a mild-to-moderate iodine deficient area.
MATERIALS AND METHODS:
Data were gathered on all newly diagnosed patients with pre-diabetes and type 2 diabetes mellitus
between May 2008 and February 2010. 156 patients with pre-diabetes and 123 patients with type 2 DM
were randomly matched for age, gender, and smoking habits with 114 subjects with normal glucose
metabolism. Serum thyroid-stimulating hormone (TSH) and thyroid ultrasonography was performed in all
participants.
RESULTS:
Mean TSH level in the diabetes group (1.9±0.9 mIU/L) was higher than in the control group (1.4±0.8 mIU/L)
and the pre-diabetes group (1.5±0.8 mIU/L) (P<0.0001 for both). Mean thyroid volume was higher in the
pre-diabetes (18.2±9.2mL) and diabetes (20.0±8.2mL) groups than in controls (11.4±3.8mL) (P<0.0001 for
both). Percentage of patients with thyroid nodules was also higher in the pre-diabetes (51.3%) and
diabetes groups (61.8%) than in controls (23.7%) (P<0.0001 for both).
CONCLUSIONS:
The results suggest that patients with impaired glucose metabolism have significantly increased thyroid
volume and nodule prevalence.
Copyright © 2013 Elsevier Inc. All rights reserved.
PMID: 23395200
http://dx.doi.org/10.1016/j.metabol.2013.01.009
10. Surgery. 2013 Sep 25. pii: S0039-6060(13)00211-0. doi: 10.1016/j.surg.2013.04.064. [Epub ahead
of print] IF: 3.19
Total thyroidectomy for Graves' disease: Compliance with American Thyroid Association guidelines may not always be necessary.
Shinall MC Jr, Broome JT, Nookala R, Shinall JB, Kiernan C, Parks L 3rd, Solórzano CC.
Source
Department of Surgery, Vanderbilt University Medical Center, Nashville, Nashville, TN. Electronic address:
Abstract
BACKGROUND:
Total thyroidectomy (TT) is the preferred operative approach to Graves' disease. Current guidelines of the
American ThyroidAssociation call for the administration of potassium iodide (KI) and achievement of
euthyroid state before operation. Small numbers and a mixture of operative approaches spanning several
decades hinder previous operative series. We present the outcomes for TT at a single high-volume center.
METHODS:
A retrospective cohort study was conducted on 165 patients undergoing TT for Graves' disease from July
2007 to May 2012.
RESULTS:
Mean age was 43 years (range, 17-78), and 128 patients (78%) were female. A total of 95% of patients
were on methimazole or propylthiouracil, and 42% remained hyperthyroid at time of TT. Only 3 (2%)
patients received KI. Mean operative time was 132 minutes (range, 59-271). Mean gland size and blood
loss were 41 g (range, 8-180) and 55 mL (range, 10-1050), respectively. No patient
developed thyroid storm. Median follow-up was 7.5 months. Temporary and permanent hypocalcemia
developed in 51 (31%) and 2 patients (1.2%), respectively. Temporary and permanent recurrent laryngeal
nerve paresis occurred in 12 (7%) and one (0.6%) patient, respectively. Sixty-one (37%) patients
experienced at least one complication. On multivariate analysis, patient age younger than 45 years (odds
ratio 2.93, 95% confidence interval 1.39-6.19) and obesity (odds ratio 2.11, 95% confidence interval 1.00-
4.43) were associated with the occurrence of complications.
CONCLUSION:
This high-volume surgeon experience demonstrates no appreciable detriment to patient outcomes when
recommendations of the American Thyroid Association for routine use of KI and euthyroid state before
thyroidectomy are not met. Transient hypocalcemia and hoarseness are frequent complications of TT for
Graves' disease, resolving within 6 months in most patients. Age younger than 45 years and obesity are
risk factors for postoperative complications.
Copyright © 2013 Mosby, Inc. All rights reserved.
PMID: 24075271
http://dx.doi.org/10.1016/j.surg.2013.04.064
11. Surgery. 2013 Jul;154(1):106-10. doi: 10.1016/j.surg.2013.02.018. IF: 3.19
Clinical significance of microscopic anaplastic focus in papillary thyroid carcinoma.
Choi JY, Hwang BH, Jung KC, Min HS, Koo do H, Youn YK, Lee KE.
Source
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Abstract
BACKGROUND:
On occasion, a microscopic anaplastic focus (MAF) is discovered in papillary thyroid carcinoma (PTC). The
relevance of MAF has not been well studied with regard to its clinical implications. MAF is defined as the
microscopic presence of focally dedifferentiated follicular cells within the PTC.
METHODS:
A total of 3,606 patients who underwent primary thyroid surgery between 1995 and 2007 were selected
from the database of Seoul National University Hospital. Patients were divided into 3 groups based on
histology: PTC without MAF (3,574 patients), PTC with MAF (13 patients), and anaplastic thyroid
carcinoma (19 patients).
RESULTS:
Mean ± standard deviation age was 48 ± 12 years (range, 17-83) in the PTC without MAF group, 57 ± 14
years (range, 29-76) in the PTC with MAF group, and 64 ± 14 years (range, 24-86) in the ATC group (P <
.001). Mean tumor sizes were 1.2 ± 0.9 cm (range, 0.5-13), 2.1 ± 1.2 cm (range, 0.7-5), and 3.7 ± 1.4 cm
(range, 0.4-6), respectively (P < .001). The median follow-up was 32 months. The cause-specific survival at
5 years was 98% in the PTC without MAF group, 64% in the PTC with MAF group, and 11% in the ATC
group (P < .001). Multivariate analysis showed that MAF was a prognostic factor for the outcome of PTC
patients (hazard ratio, 12.9; 95% confidence interval, 3.1-54.1; P < .001).
CONCLUSION:
MAF negatively influenced the prognosis of patients with PTC. Further research and the design of more
aggressive treatment strategies for MAF might be helpful for patients with PTC.
Copyright © 2013 Mosby, Inc. All rights reserved.
PMID: 23809489
http://dx.doi.org/10.1016/j.surg.2013.02.018
12. Surgery. 2013 Aug 22. pii: S0039-6060(13)00351-6. doi: 10.1016/j.surg.2013.06.029. [Epub ahead
of print] IF: 3.19
Hurthle cell carcinoma: An update on survival over the last 35 years.
Nagar S, Aschebrook-Kilfoy B, Kaplan EL, Angelos P, Grogan RH.
Source
The Endocrine Surgery Research Program, Department of Surgery, University of Chicago, Chicago, IL.
Electronic address: [email protected].
Abstract
BACKGROUND:
Hurthle cell carcinoma (HCC) of the thyroid is a variant of follicular cell carcinoma (FCC). A low incidence
and lack of long-term follow-up data have caused controversy regarding the survival characteristics of
HCC. We aimed to clarify this controversy by analyzing HCC survival over a 35-year period using the
Surveillance, Epidemiology, and End Results (SEER) database.
METHODS:
Cases of HCC and FCC were extracted from the SEER-9 database (1975-2009). Five- and 10-year
survival rates were calculated. We compared changes in survival over time by grouping cases into 5-year
intervals.
RESULTS:
We identified 1,416 cases of HCC and 4,973 cases of FCC. For cases diagnosed from 1975 to 1979, HCC
showed a worse survival compared with FCC (5 years, 75%; 95% confidence interval [CI], 60.2-85) versus
88.7% (95% CI, 86-90.8; 10 years, 66.7% [95% CI, 51.5-78.1] vs 79.7% [95% CI, 76.5-82.6]). For cases
diagnosed from 2000 to 2004 we found no difference in 5-year survival between HCC and FCC (91.1%
[95% CI, 87.6-93.7] vs 89.1% [95% CI, 86.5-91.2]). For cases diagnosed from 1995 to 1999, there was no
difference in 10-year survival between HCC and FCC (80.9% [95% CI, 75.6-85.2] vs 83.9% [95% CI, 80.8-
86.6]). HCC survival improved over the study period while FCC survival rates remained stable (increase in
survival at 5 years, 21.7% vs 0.4%; at 10 years, 21.3% vs 5.2%). Improvement in HCC survival was
observed for both genders, in age ≥45 years, in local and regional disease, for tumors >4 cm, and with
white race.
CONCLUSION:
HCC survival has improved dramatically over time such that HCC and FCC survival rates are now the
same. These findings explain how studies over the last 4 decades have shown conflicting results regarding
HCC survival; however, our data do not explain why HCC survival has improved.
Copyright © 2013 Mosby, Inc. All rights reserved.
PMID: 23973114
http://dx.doi.org/10.1016/j.surg.2013.06.029
13. World J Surg. 2013 Jul 23. [Epub ahead of print] IF: 2.47
Clinical Significance of Delphian Lymph Node Metastasis in Papillary Thyroid Carcinoma.
Oh EM, Chung YS, Lee YD.
Source
Thyroid and Endocrine Surgery Department, Gachon University Gil Hospital, 1198, Guwol-dong, Namdong-
Gu, Inchon, Republic of Korea, [email protected].
Abstract
BACKGROUND:
Delphian lymph node (DLN) metastasis has long been considered a prognostic marker of head and neck
malignancy. These days, the significance of DLN in thyroid cancer has come to the fore. The objective of
the present study was to evaluate the clinical significance of DLN metastasis in patients with
papillary thyroid cancer (PTC).
PATIENTS AND METHODS:
The study was carried out between July 2009 and December 2011, and DLN was detected in 245 of 898
PTC patients who underwent total thyroidectomy and bilateral central compartment neck dissection. In
those 245 patients DLN status was correlated with clinical and pathologic factors, including age, gender,
tumor size, extrathyroidal extension (ETE), lymphovascular invasion (LVI), and central and lateral nodal
metastasis.
RESULTS:
DLN metastasis was found in 20 % of the patients studied (49 of 245), and DLN metastasis was correlated
with tumor size, multicentricity, bilaterality, and LVI excluding ETE (all p < 0.05). The proportion of male
patients was higher in the DLN metastasis positive group than in the DLN metastasis negative group (34.7
vs. 13.3 %; p < 0.05). Most of the patients (95.9 %) with DLN metastasis had other central neck node
metastasis, and the metastatic central lymph node ratio was higher (0.38 ± 0.23 versus 0.09 ± 0.16;
p < 0.001) and lateral neck node metastasis was more common (2.6 vs. 32.7 % <0.001) than in patients
without DLN metastasis. For central and lateral compartment nodal metastasis, DLN status had sensitivity,
specificity, positive and negative predictive values of 100, 37.4, 58.1, and 100 %, and 85.3, 76.2, 97.4, and
32.7 %, respectively. Multivariate analysis showed that the factors affecting DLN involvement were tumor
size and LVI. Patients with positive DLN were ~1.6 times more likely to have further central compartment
disease and 3.6 times more likely to have lateral compartment disease.
CONCLUSIONS:
DLN metastasis in patients with PTC is related to a number of poor prognostic factors. Furthermore DLN
involvement implies that the patients are predicted to have heavy burden of central neck node metastasis
and are more likely to have further lateral neck node metastasis. It is recommended that DLN is evaluated
and dissected in all patients with thyroid cancer. If DLN metastasis is suspected, the surgeon should
thoroughly dissect the central neck compartment and pay particular attention to the lateral lymph node
compartments.
PMID: 23877804
14. World J Surg. 2013 Sep 18. [Epub ahead of print] IF: 2.47
Evaluating the Morbidity and Efficacy of Reoperative Surgery in the Central Compartment for Persistent/Recurrent Papillary Thyroid Carcinoma.
Lang BH, Lee GC, Ng CP, Wong KP, Wan KY, Lo CY.
Source
Department of Surgery, The University of Hong Kong, Hong Kong SAR, China, [email protected].
Abstract
BACKGROUND:
Although reoperative surgery in the central compartment (RCND) is indicated for bulky or progressive
persistent/recurrent papillarythyroid carcinoma (PTC), its associated morbidity and disease outcomes
remain unclear. We evaluated RCND outcomes by comparing them with those of patients who underwent
primary central neck dissection (CND).
METHODS:
After matching for age, sex, tumor size, and initial tumor stage, the morbidity and outcomes of 50
consecutive patients who underwent RCND were compared with data from 75 patients who underwent
primary therapeutic CND during the same period. Matching was performed blind to the morbidity and
disease outcome of each patient. A stimulated thyroglobulin (sTg) <2 ng/ml was considered undetectable.
RESULTS:
Relative to primary CND, the incidence of extranodal extension (p = 0.010) and size of metastatic lymph
nodes (p < 0.001) were significantly greater in the RCND group. Postoperative hypoparathyroidism and
vocal cord palsy rates were comparable in the groups. There were two esophageal injuries in the RCND
group and none in the primary CND group. The secondary CND group achieved a significantly lower
undetectable postablation sTg rate (12.0 vs. 52.0 %, p = 0.001) and worse 10-year disease-free survival
(35.6 vs. 91.8 %, p = 0.001) and cancer-specific survival (82.0 vs. 98.5 %, p = 0.001) than the primary CND
group.
CONCLUSIONS:
Although RCND for persistent/recurrent PTC was performed with morbidity comparable to that seen with
primary CND, it was associated with some serious complications. Short- and long-term disease control
appeared moderate with approximately one-tenth of patients having an undetectable sTg level 6 months
after ablation and one-third remaining clinically disease-free after 10 years.
PMID: 24045964
15. Am J Surg. 2013 Sep 4. pii: S0002-9610(13)00402-9. doi: 10.1016/j.amjsurg.2013.07.005. [Epub
ahead of print] IF: 2.39
Surgery for Graves' disease: a 25-year perspective.
Phitayakorn R, Morales-Garcia D, Wanderer J, Lubitz CC, Gaz RD, Stephen AE, Ehrenfeld JM, Daniels GH, Hodin RA, Parangi S.
Source
Thyroid Cancer Research Laboratory, Endocrine Surgery Unit, The Massachusetts General Hospital,
Harvard Medical School, 15 Parkman Street, Wang ACC 460, Boston, MA 02115, USA.
Abstract
BACKGROUND:
Optimal treatment of Graves' disease (GD) remains controversial. The authors retrospectively reviewed the
surgical cases of GD at a single academic tertiary center.
METHODS:
Demographic, clinical, and surgical data were analyzed for all patients with GD undergoing thyroidectomy
over 25 years, in 3 periods: 1985 to 1993 (n = 32), 1994 to 2002 (n = 91), and 2003 to 2010 (n = 177).
RESULTS:
There were 300 patients with GD (85.7% women; mean age, 39.3 years; median length of follow-up, 24.6
months). Overall, perioperative morbidity occurred in 36 patients (12.0%), and there was no mortality.
Thyroidectomy-specific morbidity was very low, and the incidental malignancy rate was 10.3%.
CONCLUSIONS:
Surgical treatment of GD has a very high safety profile, with low perioperative and thyroidectomy-specific
morbidity, even in patients with overt hyperthyroidism. Incidental malignancy in patients with GD is not
uncommon.
Copyright © 2013 Elsevier Inc. All rights reserved.
KEYWORDS:
Graves’ disease, Incidental malignancy, Surgical therapy
PMID: 24011567
http://dx.doi.org/10.1016/j.amjsurg.2013.07.005
16. Endocrine. 2013 Aug 29. [Epub ahead of print] IF: 2.24
Ultrasound-guided fine-needle aspiration for solid thyroid nodules larger than 10 mm: correlation between sonographic characteristics at the needle tip and nondiagnostic results.
Wu H, Zhang B, Zang Y, Wang J, Zhu B, Cao Y, Liu Q.
Source
Department of Ultrasound, Jiang Yuan Hospital Affiliated with the Jiangsu Institute of Nuclear Medicine
(Key Laboratory of Nuclear Medicine, Ministry of Health/Jiangsu Key Laboratory of Molecular Nuclear
Medicine), 20 Qianrong Rd, Wuxi, 214063, Jiangsu, China, [email protected].
Abstract
The objective of this study was to investigate the effect of the ultrasonographic (US) characteristics and
ultrasound elastography (UE) patterns on the probability of a nondiagnostic result when performing
ultrasound-guided fine-needle aspiration (UG-FNA) cytological sampling of solid thyroid nodules larger than
10 mm, to determine the efficacy of needle tip localization in UG-FNA. We retrospectively reviewed the
cytological results of 710 samples from 355 patients. We compared the US characteristics and UE patterns
between nodules with nondiagnostic and diagnostic results, using univariate and multivariate analyses.
Among the 710 samples, 81 samples (11.4 %) from 41 patients had nondiagnostic results. According to
multivariate analysis, the combinations of hypoechogenicity with avascularity [odds ratio (OR) = 2.42; 95 %
confidence interval (CI) 1.37-3.72; p < 0.05], hypoechogenicity with the "hard pattern" (OR = 2.12; 95 % CI
1.58-4.59; p < 0.05), and hypoechogenicity with avascularity and the hard pattern (OR = 2.61; 95 % CI
1.40-5.21; p < 0.05) were risk factors that increased the incidence of nondiagnostic results in UG-FNA. UG-
FNA was more likely to yield nondiagnostic results when the needle tip sampling region displayed
hypoechogenicity and avascularity in US and the hard pattern in UE.
PMID: 23990249
17. Exp Mol Pathol. 2013 Aug;95(1):62-7. doi: 10.1016/j.yexmp.2013.05.001. Epub 2013 May 16. IF:
2.21
Overexpression of miR-10a and miR-375 and downregulation of YAP1 in medullary thyroid carcinoma.
Hudson J, Duncavage E, Tamburrino A, Salerno P, Xi L, Raffeld M, Moley J, Chernock RD.
Source
Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
63110, United States.
Abstract
MicroRNAs are a primordial mechanism of gene expression control that appear to be crucial to cellular
development and may play an important role in tumor development. Much is known about the genetics of
medullary thyroid carcinomas, as approximately 25% are hereditary and harbor germ line activating
mutations in the RET gene. Somatic RET mutations are also seen in roughly 50% of sporadic medullary
thyroid carcinomas. Few studies, however, have evaluated the role of microRNA expression in these
tumors. DNA and RNA were extracted from formalin-fixed paraffin-embedded tissue blocks of 15 medullary
thyroid carcinomas [10 with RET mutations (3 hereditary) and 5 without RET mutations] and 5 non-tumor
thyroid glands. miRNA expression of 754 targets was quantitated by real-time PCR using the ABI
OpenArray miRNA assay. Three miRNAs showed significant differential expression and were validated in a
larger cohort of 59 cases by real-time PCR. Expression of potential downstream targets and upstream
regulators was also investigated by real-time PCR. miR-375 and miR-10a were significantly overexpressed,
while miR-455 was underexpressed in medullary thyroid carcinomas. Expression of all 3 miRNAs was
validated in the larger cohort of cases (miR-375, p=3.3×10(-26); miR-10a, p=5.6×10(-14); miR-455,
p=2.4×10(-4)). No significant differences in miRNA expression were found between RET mutation positive
and negative tumors nor between sporadic and hereditary tumors. Expression of the potential downstream
targets of miR-375, YAP1 (a growth inhibitor) and SLC16a2 (a transporter of thyroid hormone), was down-
regulated in the tumors suggesting that miR-375 is a negative regulator of the expression of these genes.
Thus, differential expression of miR-375, miR-10a and miR-455 may be important for tumor development
and/or reflect C-cell lineage of medullary thyroid carcinoma. Furthermore, the growth inhibitor YAP1 is
identified as a potential important downstream target of miR-375.
Copyright © 2013 Elsevier Inc. All rights reserved.
KEYWORDS:
Medullary thyroid carcinoma, YAP1, miR-10a, miR-375, miR-455, microRNA
PMID: 23685355
http://dx.doi.org/10.1016/j.yexmp.2013.05.001
18. J Surg Res. 2013 Sep;184(1):193-9. doi: 10.1016/j.jss.2013.04.084. Epub 2013 May 23. IF:
2.08
Selective lateral compartment neck dissection for thyroid cancer.
Welch K, McHenry CR.
Source
Northeast Ohio Medical University, Rootstown, Ohio.
Abstract
BACKGROUND:
Compartment-oriented lymph node dissection in patients with thyroid cancer and macroscopic lymph node
metastases reduces recurrence and improves survival. However, the extent of lymph node dissection
remains controversial. The purpose of this study was to examine the results of selective lateral
compartment neck dissection (LCND) for thyroid cancer.
METHODS:
We completed a retrospective review of patients with thyroid cancer who underwent selective LCND from
1992-2012 to determine the extent of lymph node resection, morbidity, recurrence, subsequent operations,
mortality, and duration of follow-up.
RESULTS:
A total of 45 LCNDs (five bilateral) were performed in 40 patients, 35 with differentiated thyroid cancer
(DTC) and five with medullary carcinoma. Nineteen LCNDs (42%) were completed at the time of
thyroidectomy. Levels IIA, III, IV, and VB were included in 43 LCNDs (96%) and levels IIA, III, and IV in two
LCNDs (4%). Morbidity included neck or ear numbness in 19 patients (48%), neuropathic symptoms in 14
(35%), Horner syndrome in two (5%), marginal mandibular nerve paresis in two (5%), and wound infection
in one (3%). Recurrence rate was 25% (10 patients) and one or more reoperations were performed in
seven patients (18%) with a mean follow-up of 58 ± 60 mo (range, 1-244 mo). There were 3 ipsilateral
recurrences (8%) after 40 LCNDs for DTC. Four patients died from systemic disease: three with medullary
carcinoma and one with PTC.
CONCLUSIONS:
Selective LCND is an effective therapeutic strategy for macroscopic lymph node metastases, with an 8%
recurrence rate in the ipsilateral neck in patients with DTC. Neuropathic symptoms, however, remain an
important source of morbidity.
Copyright © 2013 Elsevier Inc. All rights reserved.
KEYWORDS:
Selective lateral compartment neck dissection, Thyroid cancer
PMID: 23816244
http://dx.doi.org/10.1016/j.jss.2013.04.084
19. Cytopathology. 2013 Sep 11. doi: 10.1111/cyt.12093. [Epub ahead of print] IF: 2.05
Hürthle cell presence alters the distribution and outcome of categories in the Bethesda system for reportingthyroid cytopathology.
Yazgan A, Balci S, Dincer N, Kiyak G, Tuzun D, Ersoy R, Cakir B, Guler G.
Source
Department of Pathology, Yildirim Beyazit University Ankara Ataturk Research and Training Hospital,
Ankara, Turkey.
Abstract
OBJECTIVES:
We aimed to determine whether the presence of Hürthle cells altered the distribution of categories in the
Bethesda system for reporting thyroid cytopathology, or the expected neoplastic and malignant outcome.
METHODS:
Fine needle aspiration (FNA) cytology reports of Hürthle cells in a 2-year period were evaluated. The
distribution of Bethesda system categories and the outcome at partial or complete thyroidectomy were
compared for FNAs with and without Hürthle cells.
RESULTS:
Of 895 adequate FNAs with Hürthle cells, 764 (85.4%) were classified as benign, 86 (9.6%) as atypia of
undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 32 (3.6%) as follicular
neoplasm/suspicious for follicular neoplasm (FN/SFN), 12 (1.3%) as suspicious for malignancy (SFM) and
one (0.1%) as malignant. Of 10 359 adequate FNAs without Hürthle cells, 9707 (93.7%) were classified as
benign, 412 (4.0%) as AUS/FLUS, 77 (0.7%) as FN/SFN, 93 (0.9%) as SFM and 70 (0.7%) as malignant.
The distribution of categories in FNAs with and without Hürthle cells was significantly different (P < 0.001)
as a result of a decrease in benign and an increase in AUS/FLUS and FN/SFN categories. Among 128
patients with and 582 without Hürthle cells undergoing surgery, the overall neoplastic and malignancy rates
were higher in the former than in the latter group (27.3% versus 14.9%, P < 0.001; 21.1% versus 11.7%,
P = 0.003; respectively). Although neoplastic and malignant rates were higher in the group with than
without Hürthle cells in all categories, the differences were only significant for a neoplastic outcome of
benign cytology (15.1% versus 6.0%, P = 0.0013) and a malignant outcome of FN/SFN cytology (63.6%
versus 21.9%, P = 0.0108).
CONCLUSIONS:
We found that the rates of AUS/FLUS and FN/SFN categories in the Bethesda system were higher when
Hürthle cells were present. After surgery, neoplastic and malignant outcomes were significantly higher in
the Hürthle cell group.
© 2013 John Wiley & Sons Ltd.
KEYWORDS:
Bethesda system, Hürthle cell, fine needle aspiration cytology, thyroid cytopathology, thyroid neoplasia
PMID: 24024935
http://dx.doi.org/10.1111/cyt.12093
20. Int J Surg. 2013 Jul 31. pii: S1743-9191(13)01017-0. doi: 10.1016/j.ijsu.2013.07.010. [Epub ahead
of print] IF: 1.73
Predictive factors of malignancy in patients with cytologically suspicious for Hurthle cell neoplasm of thyroidnodules.
Lee KH, Shin JH, Ko ES, Hahn SY, Kim JS, Kim JH, Oh YL.
Source
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan
University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea;
Department of Radiology, Haeundae Paik Hospital, Inje University, College of Medicine, 1435 Jwa-dong,
Haeundae-gu, Busan 612-030, Republic of Korea.
Abstract
BACKGROUND:
Our aim was to evaluate predictive factors of malignancy in patients with cytologically suspicious for
Hurthle cell neoplasm (HCN) ofthyroid nodules.
MATERIALS AND METHODS:
We searched cases with cytologically suspicious for HCN from 11,569 ultrasound-guided fine-needle
aspirations (US-FNA) performed at our institution. Nodules that were confirmed surgically or followed-up for
at least 2 years were compared with respect to age, gender, tumor size, US diagnosis, and US findings to
predict malignancy.
RESULTS:
The incidence of cases with cytologically suspicious for HCN was 1.2% (143 of 11,569). Of 75 nodules that
underwent sufficient follow-up or surgery, malignancies were found in 11 (14.7%). Malignant histological
examination revealed oncocytic variants of papillary thyroid carcinoma (PTC) in 3 cases, classic PTC in 1,
Hurthle cell carcinoma in 3, follicular carcinoma in 3 and an unclassified carcinoma in 1. In univariate
analysis, tumor size was significantly larger in malignant nodules compared to benign nodules (p = 0.026).
The best cut-off value of tumor size in predicting malignancy was 2.5 cm. (p = 0.006, sensitivity: 63.6%,
specificity: 79.7%). The incidences of hypoechogenicity and malignant US diagnoses were higher in
malignant nodules than in benign nodules (p < 0.001). In multivariate analysis, tumor size was an
independent factor in predicting malignancies. (p = 0.037, odd ratio: 2.09, confidence interval: 1.046-
4.161).
CONCLUSION:
Preoperative US provides predictive factors of malignancy in thyroid nodules with cytologically suspicious
for HCN. Predictive factors include tumor size of 2.5 cm or greater, hypoechoic nodule and malignant US
diagnosis.
© 2013 Published by Elsevier Ltd on behalf of Surgical Associates Ltd.
KEYWORDS:
Diagnosis, Hurthle cell neoplasm, Predictive factor, Thyroid nodule, Ultrasonography
PMID: 23916366
http://dx.doi.org/10.1016/j.ijsu.2013.07.010
21. ORL J Otorhinolaryngol Relat Spec. 2013;75(4):228-39. doi: 10.1159/000353549. Epub 2013 Jul
26. IF: 1.68
Superior mediastinal dissection for papillary thyroid carcinoma: approaches and outcomes.
Liu J, Wang X, Liu S, Liu X, Tang P, Xu Z.
Source
Department of Head and Neck Surgical Oncology, Cancer Hospital, Chinese Academy of Medical
Sciences, Beijing, China.
Abstract
Background: Superior mediastinal surgery for thyroid carcinoma is not a standardized procedure like the
neck dissection. The objective of this study was to evaluate the effectiveness of superior mediastinal
dissection for mediastinal metastasis of papillary thyroid carcinoma (PTC). Methods: We conducted a
retrospective review of 119 patients who underwent superior mediastinal dissection for the treatment of
PTC. The postoperative characteristics and follow-up data were analyzed. Cox regression was performed
to identify the factors related to the mediastinal control. Results: No severe complications occurred in this
series. The five-year local (mediastinum) disease-free survival rates of comprehensive (n = 29) and partial
(n = 90) superior mediastinal dissection were 86.3 and 84.0%, respectively (log-rank = 0.562; p = 0.452).
Different patterns of superior mediastinal dissection did not turn out to be related to mediastinal recurrence
in the cox regression. Bilateral paratracheal metastasis was identified as an individual risk factor of
mediastinal recurrence with a relative risk value of 4.635 (95% CI: 1.399-15.355; p = 0.012). Conclusions:
Both partial and comprehensive superior mediastinal dissections are effective and safe for the treatment of
mediastinal metastasis of PTC if appropriately designed. © 2013 S. Karger AG, Basel.
PMID: 23900210
http://dx.doi.org/10.1159/000353549
22. Otolaryngol Head Neck Surg. 2013 Jul;149(1):47-52. doi: 10.1177/0194599813489662. Epub 2013
May 21. IF: 1.68
Neural monitored revision thyroid cancer surgery: surgical safety and thyroglobulin response.
Phelan E, Kamani D, Shin J, Randolph GW.
Source
Division of Thyroid and Parathyroid Surgery, Department of Otology and Laryngology, Massachusetts Eye
and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA.
Abstract
OBJECTIVE:
To evaluate the postoperative complications and to evaluate and stratify thyroglobulin (Tg) response
associated with revision surgery for thyroid malignancy.
STUDY DESIGN:
Case series with chart review.
SETTINGS:
Academic, tertiary care center.
SUBJECTS AND METHODS:
All patients with regionally recurrent thyroid carcinoma and who underwent revision thyroid surgery by the
senior author (GWR) during a 5-year period were identified. All patients had pre- and postoperative
laryngeal examination and underwent surgery with standardized neural monitoring. Postoperative
complications and thyroglobulin (Tg) response were recorded.
RESULTS:
One hundred seventeen cases meeting the criteria for revision surgery for recurrent thyroid cancer were
identified. Among this group, 30% presented for their third or higher revision procedure. Preoperative
permanent vocal cord palsy was present in 14% (n = 16), and 19% (n = 22) had preoperative permanent
hypocalcaemia. There were no new cases of either temporary or permanent vocal cord palsy in our study
group. Approximately 5% developed temporary and 3% permanent hypocalcaemia requiring medical
treatment. The mean basal Tg following revision surgery was 5.6 ng/ml (range, 0.2-32.7), which
represented a mean postoperative significant decline in Tg of approximately 90%. In nearly 40%, basal Tg
was undetectable postoperatively. Tg response was stratified based on the number of revision surgeries,
Tg decline was observed in 90% of all cases, 92% after first revision surgery, 85% after second, 34% after
third, and 70% after fifth revision surgeries.
CONCLUSION:
Revision thyroid cancer surgery can be performed with low rates of complications and significant impact on
Tg levels even after multiple revision surgeries.
KEYWORDS:
IONM, complications of revision surgery, hypocalcemia, hypoparathyroidism, neural monitoring, papillary thyroid carcinoma, recurrent laryngeal nerve injury, revision thyroid surgery, thyroglobulin Tg response, thyroid cancer recurrence
PMID: 23695590
http://dx.doi.org/10.1177/0194599813489662
23. Otolaryngol Head Neck Surg. 2013 Jul;149(1):53-9. doi: 10.1177/0194599813482877. Epub 2013
Mar 22. IF: 1.68
Prevalence and prediction for malignancy of additional thyroid nodules coexisting with proven papillary thyroid microcarcinoma.
Choi SY, Woo SH, Shin JH, Choi N, Son YI, Jeong HS, Baek CH, Chung MK.
Source
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, Korea.
Abstract
OBJECTIVE:
To investigate the clinical efficacy of ultrasonographic (US) classification of additional thyroid nodules
coexisting with proven papillary thyroid microcarcinoma (PTMC).
STUDY DESIGN:
Historical cohort study.
SETTING:
Tertiary care institution.
SUBJECTS AND METHODS:
In addition to the prevalence of additional thyroid nodules based on an US classification, the diagnostic
accuracy and predictive factors for malignancy were assessed in 300 nodules randomly selected from 300
patients with cytologically proven PTMC who underwent total thyroidectomy.
RESULTS:
The most common thyroid nodules were "indeterminate nodules," 68.0%, followed by "probably benign
nodules," 20.7%, and "suspicious malignant nodules," 11.3%. For indeterminate nodules, the malignancy
rate was 16.6% (34/204) with disregard to its location, either on the contralateral (15.1%, 16/106) or
ipsilateral side (18.4%, 18/98) of the known PTMC (P = .53). According to univariate and multivariate
analyses of clinical and US findings for predictive variables of malignancy in indeterminate nodules,
hypoechogenicity was proven to be the sole predictive factor for malignancy (odds ratio 5.62, 95% CI, 2.29-
13.72).
CONCLUSION:
US-based classification of additional thyroid nodules is a useful tool for decision making of the surgical
extent in patients with a single PTMC.
KEYWORDS:
papillary thyroid microcarcinoma, thyroid nodules, ultrasonography
PMID: 23525852
http://dx.doi.org/10.1177/0194599813482877
24. Otolaryngol Head Neck Surg. 2013 Sep 17. [Epub ahead of print] IF: 1.68
Electrophysiologic Monitoring Characteristics of the Recurrent Laryngeal Nerve Preoperatively Paralyzed or Invaded with Malignancy.
Kamani D, Darr EA, Randolph GW.
Source
Massachusetts Eye and Ear Infirmary, Division of Thyroid and Parathyroid Surgery, Harvard Medical
School, Boston, Massachusetts, USA.
Abstract
ObjectiveTo elucidate electrophysiologic responses of the recurrent laryngeal nerves that were
preoperatively paralyzed or invaded by malignancy and to use this information as an added functional
parameter for intraoperative management of recurrent laryngeal nerves with malignant invasion.Study
DesignCase series with chart review.SettingsAcademic, tertiary care center.Subjects and MethodsAll
consecutive neck surgeries with nerve monitoring performed by senior author (GWR) between December
1995 and January 2007 were reviewed after obtaining Institutional Review Board approval from
Massachusetts Eye and Ear Infirmary Human Subjects Committee and the Partners Human Research
Committee. Electrophysiologic parameters in all cases with preoperative vocal cord paralysis/paresis, and
the recurrent laryngeal nerve invasion by cancer, were studied.ResultsOf the 1138 surgeries performed, 25
patients (2.1%) had preoperative vocal cord dysfunction. In patients with preoperative vocal cord
dysfunction, recognizable recurrent laryngeal nerve electrophysiologic activity was preserved in over 50%
of cases. Malignant invasion of the recurrent laryngeal nerve was found in 22 patients (1.9%). Neural
invasion of the recurrent laryngeal nerve was associated with preoperative vocal cord paralysis in only 50%
of these patients. In nerves invaded by malignancy, 60% maintained recognizable electrophysiologic
activity, which was more commonly present and robust when vocal cord function was
preserved.ConclusionKnowledge of electrophysiologic intraoperative neural monitoring provides additional
functional information and, along with preoperative vocal cord function information, aids in constructing
decision algorithms regarding intraoperative management of the recurrent laryngeal nerve, in
prognosticating postoperative outcomes, and in patient counseling regarding postoperative expectations.
KEYWORDS:
EMG, IONM, electrophysiologic parameters, invasive malignancy, recurrent laryngeal nerve monitoring, surgery for thyroid cancer, thyroidmalignancy, vocal cord paralysis
PMID: 24046274
25. Eur Arch Otorhinolaryngol. 2013 Jul 20. [Epub ahead of print] IF: 1.59
Clinical characteristics of papillary thyroid microcarcinoma less than or equal to 5 mm on ultrasonography.
Lee HS, Park HS, Kim SW, Choi G, Park HS, Hong JC, Lee SG, Baek SM, Lee KD.
Source
Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Am-Nam
Dong 34, Seo-Gu, 602-702, Busan, South Korea.
Abstract
Management of papillary thyroid microcarcinoma sized ≤5 mm identified on ultrasonography is
controversial. In this study, we evaluated the clinical characteristics of papillary thyroid microcarcinoma
sized ≤5 mm on ultrasonography in comparison to those >5 mm and sought to present rationales for
optimal management in papillary thyroid microcarcinoma ≤5 mm. The medical records of 396 patients who
underwent surgery for papillary thyroidcarcinoma between 2009 and 2011 were retrospectively analyzed.
The patients were grouped into A (≤5 mm, n = 132) or B (>5 mm, n = 264) and the clinicopathologic
characteristics of the patients were reviewed and compared between the two groups. Tumor capsular
invasion (45.5 vs. 59.8 %, p = 0.007) and cervical lymph node metastasis (18.2 vs. 29.2 %, p = 0.018) were
more frequent in group B. Nonetheless, group A presented lymph node metastasis in 42.3 % of multifocal
cases showing no difference to that of group B (41.5 %, p = 0.946) and also included five cases (3.8 %) of
lateral neck metastasis. Multifocality was the only predictive factor for lymph node metastasis in group A
(p < 0.001). Over half (55.3 %) of the patients of group A were diagnosed with papillary carcinoma in
private clinics; however, only 5.5 % of these patients underwent assessment of lateral neck lymph nodes
initially. In conclusion, higher risk of cervical lymph node metastasis should be considered in evaluation and
surgical decision of papillary thyroid microcarcinoma ≤5 mm identified on ultrasonography with multifocality.
Evaluation of the cervical lymph nodes including the lateral neck should not be overlooked when
suspicious thyroid nodule suggesting malignancy sized ≤5 mm shows multifocal lesions.
PMID: 23873032
26. Laryngoscope. 2013 Oct;123(10):2583-6. doi: 10.1002/lary.23946. Epub 2013 Aug 5. IF: 1.32
The role of nerve monitoring to predict postoperative recurrent laryngeal nerve function in thyroid and parathyroid surgery.
Eid I, Miller FR, Rowan S, Otto RA.
Source
Department of Otolaryngology-HNS, University of Texas Health Science Center San Antonio, San Antonio,
Texas, U.S.A.
Abstract
OBJECTIVES/HYPOTHESIS:
To determine the role and efficacy of intraoperative recurrent laryngeal nerve (RLN) stimulation in the
prediction of early and permanent postoperative nerve function in thyroid and parathyroid surgery.
STUDY DESIGN:
A retrospective review of thyroid and parathyroid surgeries was performed with calculation of sensitivity and
specificity of the response of intraoperative stimulation for different pathological groups.
METHODS:
Normal electromyography (EMG) response with 0.5 mAmp stimulation was considered a positive
stimulation response with postoperative function determined by laryngoscopy. No EMG response at >1-2
mAmps was considered a negative response. The rates of early and permanent paralysis, as well as
sensitivity, specificity, and positive and negative predictive values for postoperative nerve function were
calculated for separate pathological groups.
RESULTS:
The number of nerves at risk analyzed was 909. The overall early and permanent paralysis rates were
3.1% and 1.2%, respectively, with the highest rate being for Grave's disease cases. The overall sensitivity
was 98.4%. The specificity was lower at 62.5% but acceptable in thyroidcarcinoma and Grave's disease
patients. The majority of nerves with a positive stimulation result and postoperative paralysis on
laryngoscopy recovered function in 3 to 12 weeks, showing positive stimulation to be a good predictor of
eventual recovery.
CONCLUSIONS:
Stimulation of the RLN during thyroid and parathyroid surgery is a useful tool in predicting postoperative
RLN function. The sensitivity of stimulation is high, showing positive stimulation to be an excellent predictor
of normal nerve function. Negative stimulation is more predictive of paralysis in cases of thyroid carcinoma
and Grave's disease.
LEVEL OF EVIDENCE:
2b. Laryngoscope, 123:2584-2587, 2013.
Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.
KEYWORDS:
Nerve monitoring, parathyroid surgery, recurrent laryngeal nerve, thyroid surgery
PMID: 23918194
http://dx.doi.org/10.1002/lary.23946
27. Diagn Cytopathol. 2013 Jul 27. doi: 10.1002/dc.23019. [Epub ahead of print] IF: 1.21
Follicular lesion of undetermined significance in thyroid FNA revisited.
Walts AE, Mirocha J, Bose S.
Source
Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
Abstract
Controversy exists regarding the validity of follicular lesion of undetermined significance (FLUS), an
indeterminate diagnostic category of The Bethesda System for Reporting Thyroid Cytopathology (BSRTC).
According to BSRTC, FLUS carries a 5-15% risk of cancer. This study was designed to determine if
cytomorphology could stratify FLUS into subgroups with different risks of malignancy. Reports of 127
consecutive FNAs reported as FLUS with subsequent tissue diagnoses were evaluated for the presence of
various cytologic features and the results were correlated with histological diagnoses. FLUS cases with
focal nuclear atypia (nuclear overlap/crowding, nuclear grooves/membrane irregularities, nuclear
enlargement, and/or nuclear pseudoinclusions) were more frequently malignant on excision whereas those
with architectural atypia (microfollicles) were more often benign on excision (P < 0.05). The presence of any
one or more of these nuclear features increased the risk of carcinoma in subsequent thyroid resection.
Papillary carcinomas predominated in excised FLUS cases with focal nuclear atypia whereas most FLUS
with architectural atypia were adenomas or hyperplastic nodules on histological evaluation. BSRTC
recommends that thyroid aspirates containing follicular cell nuclear and/or architectural atypia insufficient
for a diagnosis of suspicious for follicular neoplasm, suspicious for malignancy or malignant be classified as
FLUS. Our findings indicate that FLUS cases with focal nuclear atypia carry a risk for malignancy that is
substantially higher than that assigned to FLUS and are best classified as suspicious. FLUS cases lacking
these atypical nuclear features have a risk for malignancy that approximates the risk BSRTC has assigned
to FLUS. Diagn. Cytopathol. 2013;. © 2013 Wiley Periodicals, Inc.
Copyright © 2013 Wiley Periodicals, Inc.
KEYWORDS:
Bethesda System for Reporting Thyroid Cytopathology, follicular lesion of undetermined significance (FLUS), follicular-pattern, papillary carcinoma, thyroid
PMID: 23894017
http://dx.doi.org/: 10.1002/dc.23019
28. Ann Otol Rhinol Laryngol. 2013 Jul;122(7):450-6. IF:1
Thyroid hormone replacement therapy, surveillance ultrasonography, and fine-needle aspiration after hemithyroidectomy.
Noureldine SI, Khan A, Massasati SA, Kethman W, Kandil E.
Source
Department of Surgery, Division of Endocrine and Oncological Surgery, Tulane University School of
Medicine, New Orleans, LA 70112-2699, USA.
Abstract
OBJECTIVES:
We undertook a retrospective analysis of a single surgeon's experience at a tertiary care teaching hospital
to determine the rates of surveillance ultrasound, fine-needle aspiration (FNA), and the need for thyroid
hormone replacement therapy (THRT) after hemithyroidectomy.
METHODS:
The study population comprised 120 consecutive patients who underwent hemithyroidectomy by one
surgeon from January 2008 to June 2011. The medical records were reviewed for preoperative and
postoperative calcium levels, fiberoptic direct laryngoscopy examination of vocal fold mobility,
postoperative complications, final pathology, and postoperative follow-up.
RESULTS:
Fifteen patients required completion thyroidectomy for malignancy and were excluded from the surveillance
analysis. Of the remaining 105 patients, 10 (9.5%) required postoperative THRT. The likelihood for THRT
was significantly associated with increased age (p = 0.01) and the presence of thyroiditis (p = 0.04). Other
factors, such as gender, body mass index, residual thyroid volume, and presence of contralateral lobe
nodules, were not significantly associated with this likelihood (p > 0.05). Twenty-three patients (21.9%)
were followed with surveillance ultrasound, of whom 12 (11.4%) underwent FNA for nodule(s) in the
contralateral lobe. Seventy-eight percent of patients did not require any long-term postoperative
surveillance. There were no instances of permanent recurrent laryngeal nerve injury or hypoparathyroidism.
CONCLUSIONS:
Hemithyroidectomy is an effective and efficient option for the management of benign and suspicious thyroid
nodules. However, patients of increased age and/or with thyroiditis are at higher risk for postoperative
hypothyroidism, and should be counseled to consider total thyroidectomy to avoid the need for long-term
surveillance and the possible need for a second operation.
PMID: 23951697
TİROİD
Vaka sunumu / Vaka kontrol
1. Ann Surg. 2013 Aug;258(2):354-8. doi: 10.1097/SLA.0b013e31826c8915. IF: 6.85
The relationship between extent of thyroid cancer surgery and use of radioactive iodine.
Haymart MR, Banerjee M, Yang D, Stewart AK, Doherty GM, Koenig RJ, Griggs JJ.
Source
Divisions of Metabolism, Endocrinology, and Diabetes and Hematology/Oncology, University of Michigan,
Ann Arbor, MI 48109, USA. [email protected]
Abstract
By linking surgeon surveys to the National Cancer Database, we found that surgeons' tendency to perform
more extensive thyroid resection is associated with greater use of radioactive iodine for stage I thyroid
cancer.
OBJECTIVE:
To determine the relationships between surgeon recommendations for extent of resection and radioactive
iodine use in low-risk thyroid cancer.
BACKGROUND:
There has been an increase in thyroid cancer treatment intensity; the relationship between extent of
resection and medical treatment with radioactive iodine remains unknown.
METHODS:
We randomly surveyed thyroid surgeons affiliated with 368 hospitals with Commission on Cancer-
accredited cancer programs. Survey responses were linked to the National Cancer Database. The
relationship between extent of resection and the proportion of the American Joint Committee on Cancer
stage I well-differentiated thyroid cancer patients treated with radioactive iodine after total thyroidectomy
was assessed with multivariable weighted regression, controlling for hospital and surgeon characteristics.
RESULTS:
The survey response rate was 70% (560/804). Surgeons who recommend total thyroidectomy over
lobectomy for subcentimeter unifocal thyroid cancer were significantly more likely to recommend
prophylactic central lymph node dissection for thyroid cancer regardless of tumor size (P < 0.001). They
were also more likely to favor radioactive iodine in patients with intrathyroidal unifocal cancer ≤1 cm (P =
0.001), 1.1-2 cm (P = 0.004), as well as intrathyroidal multifocal cancer ≤1 cm (P = 0.004). In multivariable
analysis, high hospital case volume, fewer surgeon years of experience, general surgery specialty, and
preference for more extensive resection were independently associated with greater hospital-level use of
radioactive iodine for stage I disease.
CONCLUSIONS:
In addition to surgeon experience and specialty, surgeons' tendency to perform more extensive thyroid
resection is associated with greater use of radioactive iodine for stage I thyroid cancer.
PMID: 23567930
http://dx.doi.org/10.1097/SLA.0b013e31826c8915
2. J Surg Oncol. 2013 Jul;108(1):47-51. doi: 10.1002/jso.23345. Epub 2013 Apr 26. IF: 2.97
Patients' experiences following local-regional recurrence of thyroid cancer: a qualitative study.
Misra S, Meiyappan S, Heus L, Freeman J, Rotstein L, Brierley JD, Tsang RW, Rodin G, Ezzat S, Goldstein DP, Sawka AM.
Source
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND AND OBJECTIVE:
The psychosocial impact of local-regional thyroid cancer recurrence is not known. The aim of this study
was to explore thyroid cancer patients' experiences relating to diagnosis and treatment of local-regional
disease recurrence.
METHODS:
We conducted 15 semi-structured interviews with survivors of differentiated thyroid cancer who underwent
neck reoperation for recurrent disease. Participants were recruited from the clinical practices of thyroid
surgeons and endocrinologists at University Health Network and Mount Sinai Hospitals in Toronto, Ontario.
Participant interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative methods.
Saturation of themes was achieved.
RESULTS:
Local-regional recurrence of thyroid cancer was associated with significant psychological distress.
Confidence in healthcare providers as well as psychosocial support from family or social relations, were
helpful in coping with disease recurrence. After recovery from treatment, post-traumatic growth was
reported. However, questions and worry about the risk for future recurrence lingered at follow-up.
CONCLUSIONS:
Local-regional recurrence of thyroid cancer has a significant psychosocial impact on patients, and support
needs are heightened throughout the experience. Healthcare providers should strive to ensure that medical
information and psychosocial needs of such patients are met, throughout the treatment experience, as well
as at follow-up.
Copyright © 2013 Wiley Periodicals, Inc.
PMID: 23625380
http://dx.doi.org/10.1002/jso.23345
3. Am J Med Sci. 2013 Jul;346(1):73-5. doi: 10.1097/MAJ.0b013e318288a6fa. IF: 1.39
Pretibial myxedema without ophthalmopathy: an initial presentation of Graves' disease.
Lohiya S, Lohiya V, Stahl EJ.
Source
Department of Internal Medicine, Baptist Health System, Birmingham, AL 35213, USA.
Abstract
OBJECTIVE:
To report a rare case of Graves' disease without ophthalmopathy presenting with pretibial myxedema (PM)
as an initial presentation.
METHODS:
We present the clinical history, physical findings, laboratory studies and biopsy data of a 62-year-old man
with a history of uncontrolled type 2 diabetes (DM2) presenting with arm and leg skin lesions in the
absence of other physical findings. Histopathology confirmed PM. Graves' disease and its association with
PM without Graves' ophthalmopathy and the pertinent literature are reviewed.
RESULTS:
A 60-year-old man with a history of uncontrolled DM2 presented for glycemic management. He described
symptoms of anxiety, insomnia and fatigue for the last 5 to 6 months. He described diffuse chest pain,
occasionally associated with palpitations, and a 50-pound weight loss. He also complained of severe
itching and burning of his arms and legs for the past several months. Subsequent thyroid studies revealed
hyperthyroidism suggestive of Graves' disease. In the interim, he was hospitalized for atrial flutter and was
cardioverted. After being started on methimazole, his symptoms abated. His skin lesions were biopsied,
and the leg biopsy was consistent with PM. He however had no lid lag or proptosis characteristic of Graves'
disease. He subsequently underwent radioiodine ablation. His hyperglycemia was better control led after
treatment of his hyperthyroidism.
CONCLUSIONS:
PM is an autoimmune manifestation of Graves' disease. Almost all cases of thyroid dermopathy are
associated with relatively severe ophthalmopathy. Usually ophthalmopathy appears first and dermopathy
much later. However, this case represents a rare initial presentation of Graves' disease with PM without
ophthalmologic symptoms or findings. Hyperthyroidism is typically associated with worsening glycemic
control and increased insulin requirements. In patients with diabetes having hyperthyroidism, deterioration
in glycemic control should be anticipated and treatment should be adjusted accordingly. Restoration of
euthyroidism will lower the blood glucose level.
PMID: 23514670
http://dx.doi.org/10.1097/MAJ.0b013e318288a6fa
PARATİROİD
DERLEME
1. Mol Cell Endocrinol. 2013 Sep 11. pii: S0303-7207(13)00367-5. doi: 10.1016/j.mce.2013.09.005.
[Epub ahead of print] IF: 4.17
Genetic and epigenetic changes in sporadic endocrine tumors: Parathyroid tumors.
Costa-Guda J, Arnold A.
Source
Center for Molecular Medicine and Division of Endocrinology & Metabolism, University of Connecticut
School of Medicine, Farmington, CT 06030-3101, USA.
Abstract
Parathyroid neoplasia is most commonly due to benign parathyroid adenoma but rarely can be caused by
malignant parathyroid carcinoma. Evidence suggests that parathyroid carcinomas rarely, if ever, evolve
through an identifiable benign intermediate, with the notable exception of carcinomas associated with the
familial hyperparathyroidism-jaw tumor syndrome. Several genes have been directly implicated in the
pathogenesis of typical sporadic parathyroid adenoma; somatic mutations in the MEN1 tumor suppressor
gene are the most frequent finding, and alterations in the cyclin D1/PRAD1 oncogene are also firmly
established molecular drivers of sporadic adenomas. In addition, good evidence supports mutation in the
CDKN1B/p27 cyclin-dependent kinase inhibitor (CDKI) gene, and in other CDKI genes as contributing to
disease pathogenesis in this context. Somatic defects in additional genes, including β-catenin, POT1 and
EZH2 may contribute to parathyroid adenoma formation but, for most, their ability to
drive parathyroid tumorigenesis remains to be demonstrated experimentally. Further, genetic predisposition
to sporadic presentations of parathyroidadenoma appears be conferred by rare, and probably low-
penetrance, germline variants in CDKI genes and, perhaps, in other genes such as CASR and AIP. The
HRPT2 tumor suppressor gene is commonly mutated in parathyroid carcinoma.
Copyright © 2013. Published by Elsevier Ireland Ltd.
KEYWORDS:
Hyperparathyroidism, Parathyroid adenoma, Parathyroid carcinoma
PMID: 24035866
http://dx.doi.org/10.1016/j.mce.2013.09.005
PARATİROİD
PROSPEKTİF
1. Surgery. 2013 Sep 11. pii: S0039-6060(13)00471-6. doi: 10.1016/j.surg.2013.08.013. [Epub ahead
of print] IF: 3.19
Parathyroidectomy improves symptomatology and quality of life in patients with secondary hyperparathyroidism.
Cheng SP, Lee JJ, Liu TP, Yang TL, Chen HH, Wu CJ, Liu CL.
Source
Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medical College, New Taipei
City, Taiwan; Department of Pharmacology and Graduate Institute of Medical Sciences, Taipei Medical
University, Taipei, Taiwan.
Abstract
BACKGROUND:
The parathyroidectomy assessment of symptoms (PAS) score was designed initially for primary
hyperparathyroidism to provide a specific symptom assessment and was validated later in secondary and
tertiary hyperparathyroidism. The aim of our study was to evaluate changes in the PAS scores and quality
of life before and after parathyroidectomy for secondary hyperparathyroidism.
METHODS:
This prospective study included 49 consecutive patients who underwent parathyroidectomy for secondary
hyperparathyroidism. The PAS and Short Form (SF)-36 questionnaires were completed before
parathyroidectomy and at 12 months postoperatively.
RESULTS:
All 13 symptoms included in the PAS score improved significantly. The mean ± standard deviation PAS
score decreased from 545 ± 263 to 284 ± 201 (P < .0001) after parathyroidectomy. Quality of life was
enhanced in both physical (40.3 ± 17.1 to 59.0 ± 14.9; P < .0001) and mental (47.6 ± 17.1 to 63.7 ± 13.0; P
< .0001) components. The PAS score was inversely correlated with the SF-36 global score preoperatively
and postoperatively (r2 = 0.48 and 0.25; P < .001). The change in PAS score also correlated with the
change in SF-36 global score (r2 = 0.29; P < .001). Multiple linear regression analysis showed that
preoperative PAS score and bone mineral density T-score were predictors of the decrease in PAS score.
Preoperative SF-36 global score and intact parathyroid hormone levels were predictors of the increment in
SF-36 score.
CONCLUSION:
The symptom burden of secondary hyperparathyroidism has a negative impact on a patient's quality of life.
Parathyroidectomy is associated with a marked improvement in symptoms and quality of life.
Copyright © 2013 Mosby, Inc. All rights reserved.
PMID: 24035616
http://dx.doi.org/10.1016/j.surg.2013.08.013
2. Am J Surg. 2013 Jul 5. pii: S0002-9610(13)00286-9. doi: 10.1016/j.amjsurg.2013.01.038. [Epub
ahead of print] IF: 2.39
Intact parathyroid hormone measurement at 24 hours after thyroid surgery as predictor of parathyroid function at long term.
Julián MT, Balibrea JM, Granada ML, Moreno P, Alastrué A, Puig-Domingo M, Lucas A.
Source
Endocrinology and Nutrition Service, Germans Trias i Pujol University Hospital, Department of Medicine,
Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain. Electronic address:
Abstract
BACKGROUND:
There is no consensus about the usefulness of postoperative intact parathyroid hormone (iPTH)
determination to predict permanent hypoparathyroidism (pHPP). We evaluated the value of calcium (Ca2+)
and iPTH concentration at 24 hours after total thyroidectomy (TT) for predicting pHPP.
METHODS:
Ca2+ and iPTH levels from 70 consecutive patients who underwent TT were measured at 24 hours and 6
months after TT.
RESULTS:
Five patients (7.1%) developed pHPP. An iPTH concentration ≤5.8 pg/mL at 24 hours after TT identified
patients at risk for pHPP (sensitivity, 100%; specificity, 81.5%), but it was not accurate enough to predict its
development (positive predictive value, 30%). Conversely, an iPTH level >5.8 pg/mL predicted normal
parathyroid function at 6 months (negative predictive value, 100%). Compared with iPTH, a postoperative
Ca2+ level ≤1.95 mmol/L was 60% sensitive and 78.5% specific to predict pHPP.
CONCLUSIONS:
An iPTH concentration >5.8 pg/mL on the first postoperative day rules out pHPP with much better
diagnostic accuracy than Ca2+. Postoperative iPTH could be helpful in identifying patients at risk for
developing pHPP.
Copyright © 2013 Elsevier Inc. All rights reserved.
KEYWORDS:
Permanent hypoparathyroidism, Postoperative hypocalcemia, Total thyroidectomy
PMID: 23835208
http://dx.doi.org/10.1016/j.amjsurg.2013.01.038
3. J Comput Assist Tomogr. 2013 Jul-Aug;37(4):511-7. doi: 10.1097/RCT.0b013e31828beb34. IF:
1.75
Three-phase parathyroid 4-dimensional computed tomography initial experience: inexperienced readers have high accuracy and high interobserver agreement.
Sepahdari AR, Yeh MW, Rodrigues D, Khan SN, Harari A.
Source
Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los
Angeles, CA 90095, USA. [email protected]
Abstract
OBJECTIVE:
Multiphase multidetector contrast-enhanced parathyroid CT (4-dimensional computed tomography [4D-CT])
is an emerging tool for evaluating patients with primary hyperparathyroidism. Our goal was to describe the
initial performance of 2 inexperienced readers in interpretation of 4D-CT.
METHODS:
Twenty-three subjects who received 4D-CT and successful surgical exploration were studied (14 initial and
9 repeat explorations; 15 single-gland disease and 8 multigland disease) A staff neuroradiologist
prospectively interpreted all studies, and a neuroradiology fellow retrospectively interpreted all studies; their
results were compared with the surgical findings for each side of the neck separately.
RESULTS:
The prospective readings were 78% accurate overall, 97% accurate in the subset of single-gland disease
cases, and 89% accurate in re-exploration cases. There was 91% concordance in interpretation between
observers, with κ of 0.83.
CONCLUSIONS:
Initial results after implementation of 4D-CT show high accuracy of interpretation for inexperienced
observers, comparable to published data, and high interobserver agreement.
PMID: 23863525
http://dx.doi.org/10.1097/RCT.0b013e31828beb34
4. J Cancer. 2013 Jul 3;4(6):458-63. doi: 10.7150/jca.6755. Print 2013. IF: 1.04
A comparison of minimally invasive video-assisted parathyroidectomy and traditional parathyroidectomy forparathyroid adenoma.
Rio PD, Vicente D, Maestroni U, Totaro A, Pattacini GM, Avital I, Stojadinovic A, Sianesi M.
Source
1. Department of Surgery -University Hospital of Parma;
Abstract
Background: Pre-operative imaging techniques for sporadic primary hyperparathyroidism (SPHPT) and
intraoperative parathyroid hormone (ioPTH) have led to the wide spread use of minimally invasive surgical
approaches. Study Design: In our prospectively collected database, 157 subjects with SPHPT and a
preoperative diagnosis of parathyroid adenoma were treated with parathyroidectomy between January
2003 and November 2011. Subjects in group A were enrolled between January 2003 to September 2006,
and underwent traditional parathyroidectomy with intraoperative frozen section and bilateral neck
exploration. Subjects in group B were enrolled between September 2006 to November 2011, and
underwent minimally invasive video-assisted parathyroidectomy (MIVAP) with ioPTH. Operative times and
post-operative pain levels were compared between groups. Subjects were followed for a minimum of 6
months post-operatively and recurrence rates and complication rates were measured between groups.
Results: 81 subjects were enrolled in group A, and 76 subjects were enrolled in group B. Pre-operative
evaluation demonstrated that the groups were statistically similar. Significantly decreased operative times
(28min vs. 62min) and post-operative pain levels were noted in group B. Recurrence rates were similar
between group A (3.7%) and group B (2.6%). Conclusions: MIVAP with ioPTH demonstrated significantly
improved operative times and post-operative pain levels, while maintaining equivalent recurrence rates.
KEYWORDS:
Parathyroidectomy, minimally invasive surgical approach
PMID: 23901344
http://dx.doi.org/10.7150/jca.6755
5. Am Surg. 2013 Jul;79(7):681-5. IF: 0.98
Surgeon-performed ultrasound for primary hyperparathyroidism.
Schenk WG 3rd, Hanks JB, Smith PW.
Source
Department of Surgery, University of Virginia, Charlottesville, Virginia 22908, USA. [email protected]
Abstract
The role of preoperative parathyroid imaging continues to evolve. This study evaluated whether surgeon-
performed ultrasound (U/S) obviates the need for other imaging studies and leads to a focused exploration
with a high degree of surgical success. From July 2010 to February 2012, 200 patients presenting with
nonfamilial primary hyperparathyroidism underwent neck U/S in the surgeon's office. The U/S interpretation
was classified as Class 1 if an adenoma was identified with high confidence, Class 2 if a possible but not
definite enlarged gland was imaged, and Class 0 (zero) if no adenoma was identified. The findings were
correlated with subsequent intraoperative findings. There were 144 Class 1 U/Ss (72%); of 132 patients
coming to surgery, 96.2 per cent had surgical findings concordant with preoperative U/S and all had
apparent surgical cure. Twenty-nine patients (14.5%) had Class 2 U/S; the 31 per cent confirmed false-
positives in this group were usually colloid nodules. Fourteen of 27 with Class 0 U/S underwent surgery
after being offered dynamically enhanced computed tomography scan. All 200 patients were apparent
surgical cures. Surgeon-performed U/S is expedient, convenient, inexpensive, and accurate. A clearly
identified adenoma can safely lead to a focused limited exploration and avoid additional imaging 93 per
cent of the time.
PMID: 23816000
PARATİROİD
RETROSPEKTİF
1. Surgery. 2013 Jul;154(1):101-5. doi: 10.1016/j.surg.2013.03.004. IF: 3.19
Minimally invasive parathyroidectomy provides a conservative surgical option for multiple endocrine neoplasia type 1-primary hyperparathyroidism.
Versnick M, Popadich A, Sidhu S, Sywak M, Robinson B, Delbridge L.
Source
University of Sydney Endocrine Surgical Unit, and Kolling Institute of Medical Research, University of
Sydney, Sydney, Australia.
Abstract
BACKGROUND:
Many authors advocate routine subtotal parathyroidectomy or total parathyroidectomy and
autotransplantation for patients with multiple endocrine neoplasia type 1 (MEN1). Many of these patients
are young and recurrence may take decades. Four-gland parathyroid exploration carries a higher risk of
complication than minimally invasive parathyroidectomy (MIP). The aim of this study was to assess the role
of selective removal of only abnormal glands for MEN1 in the era of MIP.
METHODS:
For this retrospective, cohort study we collected data on patients undergoing parathyroidectomy for MEN1
from an endocrine surgery database. We reviewed preoperative localization studies, operative findings,
histopathology, and clinical outcomes.
RESULTS:
Twenty-six patients underwent parathyroidectomy for MEN1-associated hyperparathyroidism over the 23-
year study period. Six of 10 (60%) patients in the total parathyroidectomy group and 4 of 10 (40%) patients
in the subtotal parathyroidectomy group developed hypocalcemia. The subtotal and total
parathyroidectomy groups both had a recurrence rate of 30% with a mean follow-up rate of 106 and
133 months, respectively. The MIP group had no hypocalcemia or recurrence with a mean follow-up of
19 months.
CONCLUSION:
MIP with excision of only documented abnormal parathyroid glands provides an acceptable outcome for
patients with MEN1, avoiding the potential for permanent hypoparathyroidism in young patients. It is
accepted that recurrent disease is inevitable in these patients; however, such recurrence may take
decades to occur and may be able to be dealt with by a further focused procedure.
Copyright © 2013 Mosby, Inc. All rights reserved.
PMID: 23809488
http://dx.doi.org/10.1016/j.surg.2013.03.004
2. Surgery. 2013 Oct;154(4):714-9. doi: 10.1016/j.surg.2013.05.013. Epub 2013 Aug 23. IF: 3.19
Do giant parathyroid adenomas represent a distinct clinical entity?
Spanheimer PM, Stoltze AJ, Howe JR, Sugg SL, Lal G, Weigel RJ.
Source
Department of Surgery, University of Iowa, Iowa City, IA.
Abstract
BACKGROUND:
The size of abnormal parathyroid glands in patients with primary hyperparathyroidism (PHPT) is highly
variable, but the clinical significance of giant glands is unknown.
METHODS:
We reviewed 300 consecutive patients after parathyroidectomy for PHPT. We compared patients with
giant parathyroid adenomas (weight ≥95th percentile) with the remaining patients.
RESULTS:
Giant adenomas were defined as weight ≥95th percentile or 3.5 g (median, 0.61; range, 0.05-29.93).
Patients with giant adenomas had a greater mean preoperative calcium level, greater mean parathyroid
hormone (PTH) level, and were less likely to have multiglandular or symptomatic disease. Giant adenomas
were successfully localized on imaging in 87% of patients, which was not increased over other patients
(82%). There were no differences between the groups in age, gender, gland location, or the incidence of
persistent or recurrent hyperparathyroidism. Finally, giant glandshad an increased incidence of
symptomatic postoperative hypocalcemia, including 1 patient who required rehospitalization after removal
of a giant gland.
CONCLUSION:
Giant parathyroid adenomas have a distinct presentation characterized by single gland disease and lower
incidence of symptoms despite increased levels of calcium and PTH. Additionally, after resection of a giant
adenoma, patients are more likely to develop symptomatic hypocalcemia.
Copyright © 2013 Mosby, Inc. All rights reserved.
PMID: 23978594
http://dx.doi.org/10.1016/j.surg.2013.05.013
3. Surgery. 2013 Sep;154(3):453-60. doi: 10.1016/j.surg.2013.05.034. IF: 3.19
Efficacy of localization studies and intraoperative parathormone monitoring in the surgical management of hyperfunctioning ectopic parathyroid glands.
Albuja-Cruz MB, Allan BJ, Parikh PP, Lew JI.
Source
Division of Surgical Endocrinology, DeWitt Daughtry Family Department of Surgery, University of Miami
Leonard M. Miller School of Medicine, Miami, FL; Division of GI, Tumor and Endocrine Surgery, University
of Colorado School of Medicine, Aurora, CO. Electronic address: [email protected].
Abstract
BACKGROUND:
Hyperfunctioning ectopic glands remain an operative challenge in patients with sporadic primary
hyperparathyroidism. This study examines the incidence of ectopic glands and the utility of sestamibi scans
(MIBI), surgeon-performed ultrasonography, and intraoperative parathormone monitoring in such patients
undergoing parathyroidectomy.
METHODS:
We conducted a retrospective analysis of prospectively collected data from patients who underwent
parathyroidectomy from 1980 to 2011 for sporadic primary hyperparathyroidism at a single institution.
Demographics, localizing imaging studies, intraoperative parathyroid monitoring dynamics, and surgical
outcome for patients with hyperfunctioning ectopic parathyroid glands were studied.
RESULTS:
Among 1,195 patients who underwent parathyroidectomy for sporadic primary hyperparathyroidism, 120
patients (10%) had hyperfunctioning ectopic glands, which were localized to the neck (n = 66) and
mediastinum (n = 54). MIBI had a sensitivity of 85%, specificity of 97%, and positive predictive value (PPV)
of 91% for ectopic glands in the neck, whereas in the mediastinum there was a sensitivity of 88%,
specificity of 95%, and PPV of 86%. Surgeon-performed ultrasonography had a sensitivity of 81%,
specificity of 98%, and PPV of 95% for neck ectopic glands. The overall accuracy of surgeon-performed
ultrasonography, MIBI, and intraoperative parathyroid monitoring in the neck or mediastinum was 93%.
Overall, operative success was 93% with a multiglandular disease rate of 5%.
CONCLUSION:
A high operative success rate for hyperfunctioning ectopic glands can be achieved using localization
studies and intraoperativeparathyroid monitoring. Nevertheless, surgeon judgment remains paramount in
the operative direction of this patient population.
PMID: 23972651
http://dx.doi.org/10.1016/j.surg.2013.05.034
4. World J Surg. 2013 Aug;37(8):1966-72. doi: 10.1007/s00268-013-2054-1. IF: 2.47
Utility of intraoperative parathyroid hormone monitoring in patients with multiple endocrine neoplasia type 1-associated primary hyperparathyroidism undergoing initial parathyroidectomy.
Nilubol N, Weisbrod AB, Weinstein LS, Simonds WF, Jensen RT, Phan GQ, Hughes MS, Libutti SK, Marx S, Kebebew E.
Source
Endocrine Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of
Health, 10 Center Drive, MSC1201 Room 3-3940, Bethesda, MD 20892-1201, USA. [email protected]
Abstract
BACKGROUND:
Intraoperative parathyroid hormone monitoring (IOPTH) is a widely used adjunct for primary
hyperparathyroidism (pHPT). However, the benefit of IOPTH in familial pHPT, such as in multiple endocrine
neoplasia type I (MEN1), remains unclear.
METHODS:
We performed a retrospective analysis of 52 patients with MEN1-associated pHPT undergoing initial
parathyroidectomy with IOPTH monitoring at our institution. Parathyroid hormone (PTH) levels were
measured before skin incision and 10 min after resection of the last parathyroidgland. Variables analyzed
included percent drop of PTH from baseline and the final PTH level compared to the normal reference
range (RR).
RESULTS:
A total of 52 patients underwent initial subtotal parathyroidectomy with IOPTH. An IOPTH decrease cutoff
of ≥75 % from baseline had the highest biochemical cure rate (87 %). In the remaining 13 % who met this
cutoff, all had persistent pHPT, with ≥90 % drop of PTH from baseline. The remaining patients, who did not
meet the ≥75 % cutoff, were cured. Follow-up was available for three of four patients with final IOPTH
levels above the RR: one had persistent pHPT, two had hypoparathyroidism (50 %). When a postresection
PTH level was within the RR, 88 % of patients were cured. While considered cured from pHPT, 7 % of
patients in this group developed permanent hypoparathyroidism. When the final PTH level dropped below
the RR, 28 % developed permanent hypoparathyroidism.
CONCLUSIONS:
A cutoff in IOPTH decrease of ≥75 % from baseline has the highest biochemically cure rate in patients with
pHPT associated with MEN1. However, a 75 % cutoff in IOPTH decrease does not exclude persistent
pHPT. The absolute IOPTH value does not accurately predict postoperative hypoparathyroidism.
PMID: 23722465
http://dx.doi.org/10.1007/s00268-013-2054-1
5. Ann Thorac Surg. 2013 Aug 20. pii: S0003-4975(13)01171-5. doi:
10.1016/j.athoracsur.2013.05.084. [Epub ahead of print] IF: 2.32
Minimally Invasive Resection for Mediastinal Ectopic Parathyroid Glands.
Said SM, Cassivi SD, Allen MS, Deschamps C, Nichols FC, Shen KR, Wigle DA.
Source
Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
Abstract
BACKGROUND:
We reviewed our experience with ectopic mediastinal parathyroidectomy.
METHODS:
Between March 1980 and September 2010, mediastinal parathyroidectomy was performed in 33 patients
with hypercalcemia secondary to hyperparathyroidism.
RESULTS:
Primary hyperparathyroidism was the main diagnosis in 32 patients (97%). Technetium-sestamibi scan was
used in 23 (70%) for preoperative localization. Minimally invasive resections were performed in 18 patients
(55%), and 15 (45%) underwent open surgery. The most common minimally invasive surgery approach
was video-assisted thoracoscopy in 9 patients (27%); the most common open approach was median
sternotomy in 11 (33%). Intraoperative parathyroid hormone monitoring was used in 22 patients (67%). The
ectopic glands were intrathymic in 15 patients (45%), in the aortopulmonary window in 7 (21%), and in
other intrathoracic locations in the remaining 11 (33%). Parathyroid adenomas were identified in 21
patients (64%); parathyroid hyperplasia and carcinoma were identified in 9 (27%) and 3 (9%), respectively.
No early mortality occurred in either group. Reoperation was required in 1 patient in the minimally invasive
surgery group because of hemothorax. Morbidity occurred in 8 patients (24%), the most common of which
was hypocalcemia in 4 (12%). The mean length of stay was significantly shorter in the minimally invasive
surgery group (2 versus 6 days; p < 0.001) but mortality and morbidity were not statistically different
between the two groups (p = 0.05). Mean follow-up was 3 ± 3.7 years.
CONCLUSIONS:
Minimally invasive mediastinal parathyroidectomy has similar outcomes to open surgery, with significantly
shorter length of hospital stay.
Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
PMID: 23968765
http://dx.doi.org/10.1016/j.athoracsur.2013.05.084
6. JAMA Surg. 2013 Jul;148(7):602-6. doi: 10.1001/jamasurg.2013.104. IF: 2.21
Factors that influence parathyroid hormone half-life: determining if new intraoperative criteria are needed.
Leiker AJ, Yen TW, Eastwood DC, Doffek KM, Szabo A, Evans DB, Wang TS.
Source
Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Abstract
IMPORTANCE:
Minimally invasive parathyroidectomy using intraoperative parathyroid hormone monitoring remains the
standard approach to the majority of patients with primary hyperparathyroidism. This study demonstrates
that individual patient characteristics do not affect existing criteria for intraoperative parathyroid hormone
monitoring.
OBJECTIVE:
To identify patient characteristics, such as age, sex, race, body mass index (BMI), and renal function, that
may affect existing criteria for intraoperative parathyroid hormone (IOPTH) levels during minimally invasive
parathyroidectomy.
DESIGN:
Retrospective review of a prospectively collected parathyroid database populated from August 2005 to April
2011.
SETTING:
Academic medical center.
PARTICIPANTS:
Three hundred six patients with sporadic primary hyperparathyroidism who underwent initial
parathyroidectomy between August 2005 and April 2011.
INTERVENTIONS:
All patients underwent minimally invasive parathyroidectomy with complete IOPTH information.
MAIN OUTCOME AND MEASURES:
Individual IOPTH kinetic profiles were fitted with an exponential decay curve and individual IOPTH half-
lives were determined. Univariate and multivariate analyses were performed to determine the association
between patient demographics or laboratory data and IOPTH half-life.
RESULTS:
Mean age of the cohort was 60 years, 78.4% were female, 90.2% were white, and median BMI was 28.3.
Overall, median IOPTH half-life was 3 minutes, 9 seconds. On univariate analysis, there was no
association between IOPTH half-life and patient age, renal function, or preoperative serum calcium or
parathyroid hormone levels. Age, BMI, and an age × BMI interaction were included in the final multivariate
median regression analysis; race, sex, and glomerular filtration rate were not predictors of IOPTH half-life.
The IOPTH half-life increased with increasing BMI, an effect that diminished with increasing age and was
negligible after age 55 years (P = .001).
CONCLUSIONS AND RELEVANCE:
Body mass index, especially in younger patients, may have a role in the IOPTH half-life of patients
undergoing parathyroidectomy. However, the differences in half-life are relatively small and the clinical
implications are likely not significant. Current IOPTH criteria can continue to be applied to all patients
undergoing parathyroidectomy for sporadic primary hyperparathyroidism.
Comment in
Intraoperative parathyroid hormone criteria: the quest for perfection: Comment on "Factors that
influence parathyroid hormone half-life". [JAMA Surg. 2013]
PMID: 23677330
http://dx.doi.org/10.1001/jamasurg.2013.104
7. BMC Surg. 2013 Sep 18;13(1):36. [Epub ahead of print] IF: 2.06
Intraoperative parathyroid hormone assay during focused parathyroidectomy: the importance of 20 minutes measurement.
Calò PG, Pisano G, Loi G, Medas F, Barca L, Atzeni M, Nicolosi A. Abstract
BACKGROUND:
Parathyroid hormone (PTH) monitoring during the surgical procedure can confirm the removal of all
hyperfunctioning parathyroidtissue, as the half-life of PTH is approximately 5 min. The commonly applied
Irvin criterion is reported to correctly predict post-operative calcium levels in 96-98% of patients. However,
the PTH baseline reference concentration is markedly influenced by surgical manipulations during
preparation of the affected glands, interindividual variability of the PTH half-life and modifications in the
physiological state of the patient during surgery. The aim of this study was to evaluate the possible impact
of the measurement of intraoperative PTH 20 minutes after surgery.
METHODS:
Between 2003 and 2012, 188 patients underwent a focused parathyroidectomy associated to rapid
intraoperative PTH assay monitoring. Blood samples were collected: 1) at pre-incision time, 2) at 10 min
after gland excision and 3) at 20 min after excision, if a sufficient reduction of PTH value was not observed.
On the bases of the Irvin criterion, an intra-operative PTH drop>50% from the highest either pre-incision or
pre-excision level after parathyroid excision was considered a surgical success.
RESULTS:
A >50% decrease of PTH after gland excision compared to the highest pre-excision value occurred in
156/188 patients (83%) within 10 min and in further 12/188 after 20 minutes (6.4%). In the remaining 20
patients (10.6%) values of PTH remained substantially unchanged or decreased less than 50% and for this
reason bilateral neck exploration was performed. An additional pathologic parathyroid was removed in 9
cases, a third in one. In the other 10 cases further neck exploration by a standard cervical approach was
negative and in four of these persistent postoperative hypercalcemia was demonstrated. The overall
operative success was 97.3%. Intraoperative PTH monitoring was accurate in predicting operative success
or failure in 96.3% of patients.
CONCLUSIONS:
The 20 minutes PTH measurement appears very useful, avoiding unnecessary bilateral exploration and the
related risk of complications with only a slight increase of the duration of surgery and of the costs. PTH
values decreasing appeared to be influenced by surgical manipulations during minimally invasive
parathyroidectomy.
PMID: 24044556
8. JAMA Otolaryngol Head Neck Surg. 2013 Sep 5. doi: 10.1001/jamaoto.2013.4505. [Epub ahead of
print] IF: 1.68
Causes of Emergency Department Visits Following Thyroid and Parathyroid Surgery.
Young WG, Succar E, Hsu L, Talpos G, Ghanem TA.
Source
Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan.
Abstract
IMPORTANCE With reimbursement being increasingly tied to outcome measures, minimizing unexpected
health care needs in the postoperative period is essential. This article describes reasons for emergency
department (ED) evaluation, rates of readmission to the hospital, and significant risk factors for readmission
during the postoperative period. OBJECTIVE To describe the subset of patients requiring ED evaluation
within 30 days of thyroidectomy or parathyroidectomy and their associated risk factors. DESIGN,
SETTING, AND PATIENTS Retrospective chart review in a tertiary care center of adult patients who
underwent thyroidectomy or parathyroidectomy between January 1, 2009 and October 7, 2010. Patients
were identified from an institutional review board-approved database. Postoperative patients who visited
the emergency department (ED) within the first 30 days following surgery were selected and compared with
the postoperative patients who did not visit the ED. EXPOSURES Thyroidectomy or parathyroidectomy.
MAIN OUTCOMES AND MEASURES Statistical analysis evaluated the association of demographic and
clinical characteristics between the patients who required ER evaluation and those who did not. Clinical
characteristics evaluated included type of surgery, medical comorbidities, and proton pump inhibitor (PPI)
usage. Multiple logistic regression predicted the odds of an ED visit based on presence of diabetes,
gastroesophageal reflux disease (GERD), or PPI use. RESULTS Of the 570 patients identified, 64 patients
required a visit to the ER a total of 75 times for issues including paresthesias (n = 28), wound complications
(n = 8), and weakness (n = 6). Fifteen hospital admissions occurred for treatment of a variety of
postoperative complications. A significant association was found between the presence of diabetes
(P = .03), GERD (P = .04), and the current use of PPIs (P = .03). When controlling for diabetes and GERD,
we found that patients taking PPIs were 1.81 times more likely to visit the ED than patients not taking PPIs
(P = .04). CONCLUSIONS AND RELEVANCE Patients taking PPIs are 1.81 times more likely to require ED
evaluation than those who are not taking PPIs.
PMID: 24008557
http://dx.doi.org/10.1001/jamaoto.2013.4505
PARATİROİD
VAKA SUNUMU
1. Head Neck. 2013 Sep;35(9):E265-8. doi: 10.1002/hed.23124. Epub 2012 Aug 21. IF: 2.85
Uncommon presentations of parathyroid adenoma.
Givens DJ, Hunt JP, Bentz BG.
Source
Department of Surgery, Division of Otolaryngology, Huntsman Cancer Institute, Salt Lake City, Utah.
Abstract
BACKGROUND:
Patients with parathyroid adenomas (PAs) are commonly encountered in otolaryngology and may present
with asymptomatic hypercalcemia. Retropharyngeal hematoma and recurrent laryngeal nerve (RLN)
paralysis are less commonly encountered presentations and may be harbingers of a malignant process.
METHODS AND RESULTS:
We present 2 patients with rare presentations of parathyroid adenoma. The first is a 57-year-old man with
retropharyngeal hemorrhage and progressive airway compromise. The second is a 51-year-old woman
presenting with dysphonia who was found to have RLN paralysis. Both of these patients were found to
have benign disease.
CONCLUSIONS:
Although most patients with PA present with asymptomatic hypercalcemia, this disease entity must be
considered in patients with other unusual presentations including hemorrhagic neck masses and
dysphonia. The importance of a broad differential diagnosis and thorough workup is emphasized. © 2012
Wiley Periodicals, Inc. Head Neck, 2013.
Copyright © 2012 Wiley Periodicals, Inc.
KEYWORDS:
parathyroid adenoma, retropharyngeal hemorrhage, vocal cord paralysis
PMID: 22907766
http://dx.doi.org/10.1002/hed.23124
2. J Clin Ultrasound. 2013 Sep 4. doi: 10.1002/jcu.22090. [Epub ahead of print] IF: 0.90
Intrathyroidal parathyroid carcinoma mimicking a thyroid nodule in a MEN type 1 patient.
Lee KM, Kim EJ, Choi WS, Park WS, Kim SW.
Source
Department of Radiology, Graduate College of Medicine, Kyung Hee University, #26 Kyunghee-daero,
Dongdaemun-gu, Seoul, 130-702, Korea.
Abstract
A 59-year-old woman with classic manifestations of hyperparathyroidism associated with multiple
endocrine neoplasia type 1 presented with a right adrenal mass and two pituitary microadenomas on
imaging studies. For evaluation of hypercalcemia, 99m Tc-MIBI scintigraphy was done and showed focal
uptake at the thyroid level of the right anterior neck. Subsequent neck sonography showed several thyroid
nodules, but there was no parathyroidtumor. Percutaneous fine-needle aspiration of the dominant thyroid
nodule indicated a follicular nodule. After surgery, final histopathology revealed
intrathyroidal parathyroid carcinoma. This case illustrates the difficulty in diagnosing parathyroid carcinoma
via fine-needle aspiration. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound, 2013.
Copyright © 2013 Wiley Periodicals, Inc.
KEYWORDS:
multiple endocrine neoplasia type 1, parathyroid, carcinoma, ectopic location, ultrasonography
PMID: 24037737
http://dx.doi.org/10.1002/jcu.22090
ADRENAL
DERLEME
1. Eur Urol. 2013 Sep 20. pii: S0302-2838(13)01008-7. doi: 10.1016/j.eururo.2013.09.021. [Epub
ahead of print] IF: 10.90
Robotic Versus Laparoscopic Adrenalectomy: A Systematic Review and Meta-analysis.
Brandao LF, Autorino R, Laydner H, Haber GP, Ouzaid I, De Sio M, Perdonà S, Stein RJ, Porpiglia F, Kaouk JH.
Source
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Abstract
CONTEXT:
Over the last decade, robot-assisted adrenalectomy has been included in the surgical armamentarium for
the management of adrenalmasses.
OBJECTIVE:
To critically analyze the available evidence of studies comparing laparoscopic and robotic adrenalectomy.
EVIDENCE ACQUISITION:
A systematic literature review was performed in August 2013 using PubMed, Scopus, and Web of Science
electronic search engines. Article selection proceeded according to the search strategy based on Preferred
Reporting Items for Systematic Reviews and Meta-analysis criteria.
EVIDENCE SYNTHESIS:
Nine studies were selected for the analysis including 600 patients who underwent minimally invasive
adrenalectomy (277 robot assisted and 323 laparoscopic). Only one of the studies was a randomized
clinical trial (RCT) but of low quality according to the Jadad scale. However, the methodological quality of
included nonrandomized studies was relatively high. Body mass index was higher for the laparoscopic
group (weighted mean difference [WMD]: -2.37; 95% confidence interval [CI], - 3.01 to -1.74; p<0.00001). A
transperitoneal approach was mostly used for both techniques (72.5% of robotic cases and 75.5% of
laparoscopic cases; p=0.27). There was no significant difference between the two groups in terms of
conversion rate (odds ratio [OR]: 0.82; 95% CI, 0.39-1.75; p=0.61) and operative time (WMD: 5.88; 95%
CI, -6.02 to 17.79; p=0.33). There was a significantly longer hospital stay in the conventional laparoscopic
group (WMD: -0.43; 95% CI, -0.56 to -0.30; p<0.00001), as well as a higher estimated blood loss (WMD: -
18.21; 95% CI, -29.11 to -7.32; p=0.001). There was also no statistically significant difference in terms of
postoperative complication rate (OR: 0.04; 95% CI, -0.07 to -0.00; p=0.05) between groups. Most of the
postoperative complications were minor (80% for the robotic group and 68% for the conventional
laparoscopic group). Limitations of the present analysis are the limited sample size and including only one
low-quality RCT.
CONCLUSIONS:
Robot-assisted adrenalectomy can be performed safely and effectively with operative time and conversion
rates similar to laparoscopic adrenalectomy. In addition, it can provide potential advantages of a shorter
hospital stay, less blood loss, and lower occurrence of postoperative complications. These findings seem to
support the use of robotics for the minimally invasive surgical management of adrenal masses.
Copyright © 2013. Published by Elsevier B.V.
KEYWORDS:
Adrenalectomy, Comparative, Laparoscopic, Meta-analysis, Robotic
PMID: 24079955
http://dx.doi.org/10.1016/j.eururo.2013.09.021
2. Mol Cell Endocrinol. 2013 Aug 7. pii: S0303-7207(13)00327-4. doi: 10.1016/j.mce.2013.07.032.
[Epub ahead of print] IF: 4.17
Familial pheochromocytomas and paragangliomas.
King KS, Pacak K.
Source
Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child
Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.
Abstract
Pheochromocytomas and paragangliomas are neural crest cell tumors of the adrenal medulla and
parasympathetic/sympathetic ganglia, respectively, that are often associated with catecholamine
production. Genetic research over the years has led to our current understanding of the association 13
susceptibility genes with the development of these tumors. Most of the susceptibility genes are now
associated with specific clinical presentations, biochemical makeup, tumor location, and associated
neoplasms. Recent scientific advances have highlighted the role of somatic mutations in the development
of pheochromocytoma/paraganglioma as well as the usefulness of immunohistochemistry in triaging
genetic testing. We can now approach genetic testing in pheochromocytoma/paraganglioma patients in a
very organized scientific way allowing for the reduction of both the financial and emotional burden on the
patient. The discovery of genetic predispositions to the development of pheochromocytoma/paraganglioma
not only facilitates better understanding of these tumors but will also lead to improved diagnosis and
treatment of this disease.
Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
KEYWORDS:
MEN2, NF1, Paraganglioma, Pheochromocytoma, SDHA, VHL
PMID: 23933153
http://dx.doi.org/10.1016/j.mce.2013.07.032
3. Arch Pathol Lab Med. 2013 Jul;137(7):1009-14. doi: 10.5858/arpa.2012-0291-RS. IF: 3.27
Adrenal schwannoma: a rare type of adrenal incidentaloma.
Mohiuddin Y, Gilliland MG.
Source
Department of Pathology and Laboratory Medicine, Brody School of Medicine at East Carolina University,
Greenville, North Carolina 27858-4353, USA. [email protected]
Abstract
Adrenal schwannoma is a rare type of adrenal incidentaloma, an adrenal lesion found incidentally, usually
on imaging or autopsy. Computed tomography and magnetic resonance imaging are tools used to evaluate
adrenal lesions. The diagnosis of adrenal schwannoma, however, cannot be made on imaging alone.
Surgical resection is the primary means of management of adrenal schwannomas, as it is not possible to
distinguish the schwannoma from malignant entities simply based on imaging. Histopathologic features of
adrenal schwannomas are similar to those of schwannomas found at other sites. Conventional
schwannomas, consisting of alternating Antoni A and Antoni B areas as well as Verocay bodies, have
distinct microscopic features and can be readily distinguished from other entities. Cellular schwannomas,
on the other hand, consist only of intersecting fascicles of spindle cells or Antoni A areas, resulting in a
wide differential diagnosis. Ancillary studies such as immunohistochemical analysis and electron
microscopy can help to provide a specific diagnosis.
PMID: 23808475
http://dx.doi.org/10.5858/arpa.2012-0291-RS
4. J Comput Assist Tomogr. 2013 Jul-Aug;37(4):528-42. doi: 10.1097/RCT.0b013e31828b690d. IF:
1.75
Adrenal masses: contemporary imaging characterization.
Malayeri AA, Zaheer A, Fishman EK, Macura KJ.
Source
Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institution, Baltimore, MD
21287, USA. [email protected]
Abstract
Adrenal masses are among the most common incidentally discovered lesions on cross-sectional imaging
with estimated incidence of approximately 5%. In addition, adrenal lesions can also be detected as part of
an endocrinology workup with suspicion of a functional adrenal mass. Regardless of the source of
detection, it is crucial to differentiate a benign from a malignant process and furthermore utilize
characteristic imaging appearance of different adrenal masses to facilitate diagnosis and guide
management. There are numerous imaging protocols and postprocessing methods for evaluation of
adrenal masses with high sensitivity and specificity with small differences between institutions. Currently,
the most widely used imaging modality for evaluation of adrenal mass is computed tomography without and
with contrast washout assessment. In this article, we review diagnostic approaches to adrenal masses
using computed tomography and magnetic resonance imaging techniques and present imaging strategies
utilized at our institution. The advantages and challenges of these imaging modalities for evaluation of
adrenal pathologies are discussed.
PMID: 23863528
http://dx.doi.org/10.1097/RCT.0b013e31828b690d
5. S D Med. 2013 Jul;66(7):267, 269-70. IF: 0.15
Pheochromocytoma - review and biochemical workup.
Miller RA, Ohrt DW.
Source
Sanford School of Medicine, University of South Dakota, USA.
Abstract
A commonly received question in the clinical laboratory is as follows: what is the best test for
pheochromocytoma? A widely variable presentation and potentially catastrophic consequence make this a
feared neoplasm despite its infrequent encounter. Because various biochemical testing modalities are
available, test selection is often confusing. This selection process can be made easier through a better
understanding of catecholamine producing neoplasms. The aim of this article is to provide a review of
catecholamine producing neoplasms and give recommendations on appropriate test selection.
PMID: 23957112
ADRENAL
RETROSPEKTİF
1. J Clin Endocrinol Metab. 2013 Sep 12. [Epub ahead of print] IF: 7.02
The Characterization of Pheochromocytoma and Its Impact on Overall Survival in Multiple Endocrine Neoplasia Type 2.
Thosani S, Ayala-Ramirez M, Palmer L, Hu MI, Rich T, Gagel RF, Cote G, Waguespack SG, Habra MA, Jimenez C.
Source
The Department of Endocrine Neoplasia and Hormonal Disorders (S.T., M.A.-R., M.I.H., R.F.G., G.C.,
S.G.W., M.A.H., C.J.), Division of Internal Medicine, University of Texas-MD Anderson Cancer Center; The
Department of Biostatistics (L.P.), University of Texas-MD Anderson Cancer Center; and Clinical Cancer
Genetics Program (T.R.), University of Texas-MD Anderson Cancer Center, Houston, Texas.
Abstract
Context:Pheochromocytoma (PHEO) occurs in 50% of patients with multiple endocrine neoplasia type 2
(MEN2). It is unknown if association with PHEO is associated with more aggressive
medullary thyroid cancer (MTC).Objective:To present our experience with MEN2 PHEO and evaluate
whether PHEO impacts MTC overall survival in patients with RET codon 634 mutations.Design:We
performed a retrospective chart review of MEN2 patients at MD Anderson Cancer Center from 1960
through 2012.Patients:The study group comprised of 85 patients (group 1) with MEN2 associated PHEO.
Of these, 59 patients (subgroup 1) with RET codon 634 mutations were compared to 48 patients (group 2)
with RET codon 634 mutations, but without MEN 2-associated PHEO.Main Outcome Measures:Of 85
patients with MEN2 and PHEO, 70 had MEN2A and 15 had MEN2B. Median age at PHEO diagnosis was
32 years. The initial manifestation of MEN2 was MTC in 60% of patients, synchronous MTC and PHEO in
34%, and PHEO in 6% of patients. 72% of patients had bilateral PHEO, and most tumors were
synchronous (82%). Subgroup analysis of MEN2 patients with and without PHEO, who were carriers of
RET codon 634, the most common mutation with PHEO, showed no significant differences in the stage of
MTC at initial diagnosis. The median follow-up time for patients with PHEO was 249 months and without
PHEO was 67 months (p<.01). Survival analyses among RET 634 carriers didn't show shorter survival for
patients with PHEO. The median survival time for patients with PHEO was 499 months and without PHEO
was 444 months (p<.05).Conclusions:PHEO in MEN2 patients are usually bilateral and unlikely to be
metastatic. Subgroup analysis of patients RET 634 mutations with and without PHEO, showed that PHEO
was not associated with a more advanced stage of MTC at diagnosis or a shorter survival.
PMID: 24030942
2. Am J Surg Pathol. 2013 Aug;37(8):1140-9. doi: 10.1097/PAS.0b013e318285f6a2. IF: 5.53
Adrenal cortical adenoma: the fourth component of the Carney triad and an association with subclinical Cushing syndrome.
Carney JA, Stratakis CA, Young WF Jr.
Source
Department of Laboratory Medicine and Pathology, Division of Endocrinology, Diabetes, Metabolism and
Nutrition, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. [email protected]
Abstract
The Carney triad is the combination of gastric stromal sarcoma, pulmonary chondroma, and extra-adrenal
paraganglioma. Herein, we describe the clinical, imaging, pathologic, and follow-up findings from 14
patients for a fourth component of the syndrome, adrenal adenoma. The adrenal neoplasm was
asymptomatic and usually a late finding. Results of adrenocortical function tests were normal. Computed
tomography revealed low-density adrenal masses that were consistent with adenomas. Bilateral lesions
were present in 4 patients. In 13 of the 14 patients who underwent surgery, resected adrenal glands and
biopsy specimens featured 1 or more circumscribed, yellow tumors, up to 3.5 cm in diameter, composed of
well-differentiated polygonal cells with clear vacuolated cytoplasm and a smaller component of eosinophilic
cells. The extratumoral cortex had combinations of normal histologic features, discrete clear cell
micronodules, zonal clear cell hypertrophy, and marked atrophy. The lesion in the 14th patient was
different, grossly and microscopically resembling the usual sporadic cortisol-secreting adenoma. After the
tumor was excised, the patient required glucocorticoid support. None of the tumors recurred or
metastasized. Fourteen additional patients had unilateral or bilateral adrenal tumors consistent with
adenomas detected by imaging studies.
PMID: 23681078
http://dx.doi.org/10.1097/PAS.0b013e318285f6a2
3. Ann Surg Oncol. 2013 Sep 18. [Epub ahead of print] IF: 4.33
Long-Term Survival After Adrenalectomy for Stage I/II Adrenocortical Carcinoma (ACC): A Retrospective Comparative Cohort Study of Laparoscopic Versus Open Approach.
Donatini G, Caiazzo R, Do Cao C, Aubert S, Zerrweck C, El-Kathib Z, Gauthier T, Leteurtre E, Wemeau JL, Vantyghem MC, Carnaille B, Pattou F.
Source
Department of General and Endocrine Surgery, Lille Regional University Hospital, Lille, France.
Abstract
BACKGROUND:
Laparoscopic adrenalectomy (LA) is the standard treatment for benign adrenal lesions. The laparoscopic
approach has also been increasingly accepted for adrenal metastases but remains controversial for
adrenocortical carcinoma (ACC). In a retrospective cohort study we compared the outcome of LA versus
open adrenalectomy (OA) in the treatment of stage I and II ACC.
METHODS:
This was a double cohort study comparing the outcome of patients with stage I/II ACC and a tumor size
<10 cm submitted to LA or OA at Lille University Hospital referral center from 1985 to 2011. Main outcomes
analyzed were: postoperative morbidity, overall survival, and disease-free survival.
RESULTS:
Among 111 consecutive patients operated on for ACC, 34 met the inclusion criteria. LA and OA were
performed in 13 and 21 patients, respectively. Baseline patient characteristics (gender, age, tumor size,
hormonal secretion) were similar between groups. There was no difference in postoperative morbidity, but
patients in LA group were discharged earlier (p < 0.02). After a similar follow-up (66 ± 52 for LA and
51 ± 43 months for OA), Kaplan-Meier estimates of disease-specific survival and disease-free survival were
identical in both groups (p = 0.65, p = 0.96, respectively).
CONCLUSIONS:
LA was associated with a shorter length of stay and did not compromise the long-term oncological outcome
of patients operated on for stage I/II ACC ≤ 10 cm ACC. Our results suggest that LA can be safely
proposed to patients with potentially malignant adrenal lesions smaller than 10 cm and without evidence of
extra-adrenal extension.
PMID: 24046101
4. Ann Surg Oncol. 2013 Jul 25. [Epub ahead of print] IF: 4.33
Discriminating Pheochromocytomas from Other Adrenal Lesions: The Dilemma of Elevated Catecholamines.
Carr JC, Spanheimer PM, Rajput M, Dahdaleh FS, Lal G, Weigel RJ, Sugg SL, Liao J, Howe JR.
Source
Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Abstract
BACKGROUND:
Screening tests for pheochromocytoma involve measuring levels of catecholamines in the urine or plasma,
which have significant false-positive rates. We reviewed patients with adrenal masses and elevated levels
of catecholamines to determine the value of different preoperative tests in diagnosing pheochromocytomas.
METHODS:
A retrospective chart review identified patients who underwent adrenalectomy between 1997 and 2011 with
elevation of urine or serum catecholamines. A database of clinicopathologic factors was created including
preoperative urine and plasma metanephrines, normetanephrines, vanillylmandelic acid, and fractionated
catecholamines, and tumor dimensions on imaging and pathology.
RESULTS:
A total of 70 patients underwent adrenalectomy because of presence of an adrenal mass and elevation of
catecholamines or normetanephrines or metanephrines. Of these, 46 had pathologically confirmed
pheochromocytomas. To improve our ability to discriminate between pheochromocytoma and other
pathology, we examined different combinations of clinicopathologic factors and catecholamine levels and
found the best test was a scoring system. Points are awarded for a hierarchy of elevated normetanephrine,
norepinephrine, metanephrines, with additional points received for age <50 and size on imaging >3.3 cm. A
score of 2 is suggestive of pheochromocytoma, with a positive predictive value of 86-87 %, while a score of
4 is diagnostic with positive predictive value of 100 %.
CONCLUSION:
We found that urine/serum normetanephrine levels were the most valuable screening tool; however, a
score examining the size ofadrenal mass on preoperative CT, age, and either plasma or urine
norepinephrine, metanephrine, and normetanephrine values leads to a higher positive predictive value,
making this scoring system superior to individual lab tests.
PMID: 23884753
5. Ann Surg Oncol. 2013 Jul 18. [Epub ahead of print] IF: 4.33
Robotic Versus Laparoscopic Adrenalectomy for Pheochromocytoma.
Aliyev S, Karabulut K, Agcaoglu O, Wolf K, Mitchell J, Siperstein A, Berber E.
Source
Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA.
Abstract
BACKGROUND:
Although initial reports demonstrated the safety and feasibility of robotic adrenalectomy (RA), there are
scant data on the use of this approach for pheochromocytoma. The aim of this study is to compare
perioperative outcomes and efficacy of RA versus laparoscopic adrenalectomy (LA) for
pheochromocytoma.
METHODS:
Within 3 years, 25 patients underwent 26 RA procedures for pheochromocytoma. These patients were
compared with 40 patients who underwent 42 LA procedures before the start of the robotic program. Data
were retrospectively reviewed from a prospectively maintained, IRB-approvedadrenal database.
RESULTS:
Demographic and clinical parameters at presentation were similar between the groups, except for a larger
tumor size in the robotic group. In both groups, skin-to-skin operative time, estimated blood loss less, and
intraoperative hemodynamic parameters were similar. The conversion to open rate was 3.9 % in the robotic
and 7.5 % in the laparoscopic group (p = .532). There was no morbidity or mortality in the robotic group;
morbidity was 10 % (p = .041) and mortality 2.5 % in the laparoscopic group. The pain score on
postoperative day 1 was lower, and the length of hospital stay shorter in the robotic group (1.2 ± .1 vs.
1.7 ± .1 days, p = .036).
CONCLUSIONS:
To our knowledge, this is the first study comparing robotic versus laparoscopic resection of
pheochromocytoma. Our results show that the robotic approach is similar to the laparoscopic regarding
safety and efficacy. The lower morbidity, less immediate postoperative pain, and shorter hospital stay
observed in the robotic approach warrant further investigation in future larger studies.
PMID: 23864309
6. Eur J Endocrinol. 2013 Jun 7;169(1):83-9. doi: 10.1530/EJE-13-0142. Print 2013 Jul. IF: 3.64
Surgery for adrenocortical carcinoma in The Netherlands: analysis of the national cancer registry data.
Kerkhofs TM, Verhoeven RH, Bonjer HJ, van Dijkum EJ, Vriens MR, De Vries J, Van Eijck
CH, Bonsing BA, Van de Poll-Franse LV, Haak HR; Dutch Adrenal Network.
Source
Department of Internal Medicine, Máxima Medical Center, Ds. Theodor Fliednerstraat 1, 5631 BM
Eindhoven, Veldhoven, The Netherlands. [email protected]
Abstract
OBJECTIVE:
Adrenocortical carcinoma (ACC) is a rare disease with an estimated incidence of one to two cases per 1
million inhabitants. The Dutch Adrenal Network (DAN) was initiated with the aim to improve patient care
and to stimulate scientific research on ACC. Currently, not all patients with ACC are treated in specialized
DAN hospitals. The objective of the current investigation was to determine whether there are differences in
survival between patients operated on in DAN hospitals and those operated on in non-DAN hospitals.
DESIGN:
The study was set up as a retrospective and population-based survival analysis.
METHODS:
Data on all adult ACC patients diagnosed between 1999 and 2009 were obtained from The Netherlands
Cancer Registry (NCR). Overall survival was calculated and a comparison was made between DAN and
non-DAN hospitals.
RESULTS:
The NCR contained data of 189 patients. The median survival of patients with European Network for the
Study of Adrenal Tumors stages I-III disease was significantly longer for patients operated on in a DAN
hospital (n=46) than for those operated on in a non-DAN hospital (n=37, 5-year survival 63 vs 42%).
Survival remained significantly different after correction for sex, age, year of diagnosis, and stage of
disease in the multivariate analysis (hazard ratio 1.96 (95% CI 1.01-3.81), P=0.047).
CONCLUSION:
The results associate surgery in a DAN center with a survival benefit for patients with local or locally
advanced ACC. We hypothesize that a multidisciplinary approach for these patients explains the observed
survival benefit. These findings should be carefully considered in view of the aim for further centralization of
ACC treatment.
PMID: 23641018
http://dx.doi.org/10.1530/EJE-13-0142
7. Eur J Endocrinol. 2013 Jun 1;169(1):51-8. doi: 10.1530/EJE-13-0093. Print 2013 Jul. IF: 3.64
Mutational analyses of epidermal growth factor receptor and downstream pathways in adrenocortical carcinoma.
Hermsen IG, Haak HR, de Krijger RR, Kerkhofs TM, Feelders RA, de Herder WW, Wilmink
H, Smit JW, Gelderblom H, de Miranda NF, van Eijk R, van Wezel T,Morreau H.
Source
Department of Internal Medicine, Máxima Medical Centre, PO Box 90052, 5600 PD Eindhoven, The
Netherlands. [email protected]
Abstract
BACKGROUND:
Adrenocortical carcinoma (ACC) is a rare disease with a poor prognosis and limited therapeutic options.
Mitotane is considered the standard first-line therapy with only 30% of the patients showing objective
tumour response. Defining predictive factors for response is therefore of clinical importance. The epidermal
growth factor receptor (EGFR) has been implicated in the development of one-third of all malignancies.
EGFR pathway members in ACC have been investigated, however, without available clinical data and
relation to survival.
METHODS:
In this study, mutation status of EGFR and downstream signalling pathways was evaluated in 47 ACC
patients on mitotane using direct sequencing, a TaqMan allele-specific assay and immunohistochemistry.
Archival formalin-fixed paraffin-embedded tumour tissue was used for all analyses. Patient data were
obtained anonymously, after coupling with the collected tumour tissue.
RESULTS:
One BRAF, two EGFR TK domain (c.2590> A, p.864A>T) and 11 TP53, but no PIK3CA or KRAS,
mutations were found. No relationship was found between mutation status, immunostaining and mitotane
response or survival.
CONCLUSION:
In conclusion, our data suggest that the role of EGFR tyrosine kinase inhibitors in ACC is limited.
Treatment with EGFR monoclonal antibodies on the other hand might be beneficial for a larger group of
patients. The possible efficacy of this therapy in ACC should be evaluated in future trials.
PMID: 23585556
http://dx.doi.org/10.1530/EJE-13-0093
8. AJR Am J Roentgenol. 2013 Jul;201(1):122-7. doi: 10.2214/AJR.12.9620. IF: 3.25
Can established CT attenuation and washout criteria for adrenal adenoma accurately exclude pheochromocytoma?
Patel J, Davenport MS, Cohan RH, Caoili EM.
Source
Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, B2 A209P,
Ann Arbor, MI 48109, USA.
Abstract
OBJECTIVE:
The purpose of this article is to determine the proportion of pheochromocytomas that mimic adrenal
adenoma using established CT washout and attenuation criteria.
MATERIALS AND METHODS:
The CT characteristics of pheochromocytomas confirmed by histologic analysis (n = 46) and (131)I-
metaiodobenzylguanidine (n = 1) were compared with those of 98 adrenal adenomas (negative plasma and
urinary metanephrines or catecholamines, and one or more of the following characteristics: unenhanced
attenuation ≤ 10 HU, absolute washout ≥ 60%, and relative washout ≥ 40%). CT numbers were measured
in all available phases (unenhanced [n = 37], 1-minute contrast enhanced [n = 46], and delayed contrast
enhanced [n = 43]) using a region of interest that encompassed the majority of the mass. Absolute
washout, relative washout, and degree of enhancement (1-minute minus unenhanced) were calculated.
Mass size and heterogeneity were recorded and compared using the Student t test and a chi-square test,
respectively.
RESULTS:
Twenty-four of 47 (51%) pheochromocytomas were imaged with a triphasic examination using a 15-minute
delay. Eight of 24 (33%) met relative (6/24 [25%]) or absolute (7/24 [29%]) washout criteria for the
diagnosis of a lipid-poor adenoma. Four of these (50% [4/8]) were homogeneous on all three phases. None
of the pheochromocytomas had an unenhanced attenuation of 10 HU or less. Pheochromocytomas were
significantly larger than adrenal adenomas (mean diameter, 3.9 cm [range, 0.6-14 cm] vs 2.0 cm [range,
0.8-3.9 cm]; p < 0.0001) and were significantly less likely to be homogeneous (15/47 [32%] vs 95/98 [97%];
p < 0.0001), but there was overlap.
CONCLUSION:
A substantial minority of pheochromocytomas have absolute or relative washout characteristics that
overlap with those of lipid-poor adenomas.
PMID: 23789665
http://dx.doi.org/10.2214/AJR.12.9620
9. J Endourol. 2013 Sep 4. [Epub ahead of print] IF: 2.36
Retroperitoneal Laparoendoscopic single-site adrenalectomy for pheochromocytoma: our single centre experiences.
Yuan X, Wang D, Zhang X, Cao X, Bai T.
Source
Shanxi Medical University, Taiyuan, Shanxi , China ; [email protected].
Abstract
Objective: To evaluate the feasibility and safety of retroperitoneal laparoendoscopic single-site
adrenalectomy for pheochromocytoma (LESS-PHEO) and summarize our initial experience. Patients and
Methods: Between June 2009 and June 2013, 21 patients with adrenal pheochromocytoma underwent
adrenalectomy via LESS-PHEO in our department. Fifty three patients with pheochromocytoma underwent
conventional retrolaparoscopic adrenalectomy (RLAP-PHEO) between March 2001 and June 2013, of
whom 42 were selected as a control group for a retrospective serial case-control analysis (1:2 matched-pair
cohort). In the operation, the retroperitoneal space was created and dilated by blunt finger dissection and
the pneumoperitoneal pressure was maintained below 10 mm Hg. As the first step, ligation of
the adrenal central vein was performed. Intraoperative hemodynamic parameters, operating time,
estimated blood loss, transfusion requirement, incidence of perioperative complications, visual analog pain
scale (VAPS) score, time to resumption of oral intake and ambulation, and postoperative hospitalization
were compared between the groups. Results: All the operations were technically successful, without
reoperations or conversion to open procedures. The 24-hour postoperative VAPS score was lower in the
LESS-PHEO group than in the control group (5 versus 7; P < 0.001). Despite a longer median operative
time (167.4 min versus 125.5 min; P < 0.001), the patients in the LESS-PHEO group resumed oral intake
sooner (1 day versus 2 days; P < 0.001), ambulated sooner (1 day versus 2 days; P < 0.001), and were
discharged earlier (4 days versus 7 days; P < 0.001). No perioperative complications occurred in either
group. No statistically significant differences in hemodynamic parameters or estimated blood loss were
found between the groups. Conclusion: Although more training and practice are needed to shorten its
operative time, LESS-PHEO, as performed by an experienced laparoscopic urologist, is a feasible and safe
procedure associated with less postoperative pain and faster recovery.
PMID: 24004249
10. J Endourol. 2013 Sep 2. [Epub ahead of print] IF: 2.36
Perioperative, Functional, and Oncologic Outcomes of Partial Adrenalectomy for Multiple Ipsilateral Pheochromocytomas.
Gupta GN, Benson JS, Ross M, Menon VS, Lin KY, Pinto P, Linehan WM, Bratslavsky G.
Source
Loyola University Medical Center, Urology, Maywood, Illinois, United States ; [email protected].
Abstract
Objective Managing patients with multiple adrenal masses is technically challenging. We present our
experience with minimally invasive partial adrenalectomy performed for synchronous multiple ipsilateral
pheochromocytomas in a single setting. Materials and Methods We reviewed records of patients
undergoing partial adrenalectomy for pheochromocytoma at the National Cancer Institute between 1994
and 2010. Patients were included if multiple tumors were excised from the ipsilateral adrenal gland in the
same operative setting. Perioperative, functional, and oncologic outcomes of partial adrenalectomy for
multiple pheochromocytomas is shown. Results Of 121 partial adrenalectomies performed, 10 procedures
performed in eight patients for synchronous multiple ipsilateral pheochromocytomas were identified. All
eight patients were symptomatic at presentation. The mean patient age was 30.6 yrs, median follow up was
12 months. The average surgical time was 228 minutes, average blood loss of 125 mL, average number of
tumors removed was 2.6 per adrenal. In total 26 tumors were removed, 24 were pathologically confirmed
pheochromocytoma while two were adrenal-cortical hyperplasia. After surgery all patients had resolution of
their symptoms, one patient required steroid replacement post operatively. On post operative imaging, one
patient had evidence of ipsilateral adrenal nodule at the prior resection site two months post operatively,
which was consistent with incomplete resection. Conclusions Minimally invasive surgical resection of
synchronous multiple pheochromocytomas is feasible with acceptable perioperative, functional, and
oncologic outcomes.
PMID: 23998199
11. Clin Radiol. 2013 Jul;68(7):696-703. doi: 10.1016/j.crad.2013.01.016. Epub 2013 Mar 5. IF: 2.15
Distinguishing adrenal adenomas from non-adenomas on dynamic enhanced CT: a comparison of 5 and 10 min delays after intravenous contrast medium injection.
Kumagae Y, Fukukura Y, Takumi K, Shindo T, Tateyama A, Kamiyama T, Kamimura K, Nakajo
M.
Source
Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences,
Kagoshima City, Japan. Electronic address: [email protected].
Abstract
AIM:
To evaluate the usefulness of several parameters of 5 min compared to 10 min delayed contrast-enhanced
CT in distinguishing adenomas from non-adenomas.
MATERIALS AND METHODS:
The study population consisted of 94 patients (52 men and 42 women; mean age 62 years) with 103
adrenal lesions (75 adenomas and 28 non-adenomas). In each patient, unenhanced CT was followed by
early, 5 and 10 min enhanced CT. Diagnostic parameters included delayed enhanced attenuation at 5 and
10 min, washout attenuation (WO) at 5 and 10 min, absolute percentage washout (APW) at 5 and 10 min,
and relative percentage washout (RPW) at 5 and 10 min. The accuracy of each parameter for diagnosing
adenomas from non-adenomas was calculated using receiver operating characteristic (ROC) analysis.
RESULTS:
Upon comparison between 5 and 10 min delayed contrast-enhanced CT for differentiating total adenomas
or lipid-poor adenomas from non-adenomas, there was no significant difference in the area under the
binomial ROC curve (Az) values of delayed enhanced attenuation (total adenomas versus non-adenomas,
p = 0.164; lipid-poor adenomas versus non-adenomas, p = 0.178), WO (total adenomas versus non-
adenomas, p = 0.216; lipid-poor adenomas versus non-adenomas, p = 0.230), APW (total adenomas
versus non-adenomas, p = 0.401; lipid-poor adenomas versus non-adenomas, p = 0.870), or RPW (total
adenomas versus non-adenomas, p = 0.160; lipid-poor adenomas versus non-adenomas, p = 0.780).
CONCLUSION:
Five minute contrast-enhanced CT was as useful as 10 min contrast-enhanced CT for differentiation of
adrenal adenomas from non-adenomas.
Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
PMID: 23482305
http://dx.doi.org/10.1016/j.crad.2013.01.016
12. Urol Int. 2013 Sep 17. [Epub ahead of print] IF: 1.26
Laparoendoscopic Single-Site Retroperitoneoscopic Adrenalectomy versus Conventional Retroperitoneoscopic Adrenalectomy: Initial Experience by the Same Laparoscopic Surgeon.
Wen SC, Yeh HC, Wu WJ, Chou YH, Huang CH, Li CC.
Source
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung,
Taiwan.
Abstract
Purpose: The purpose of this study was to demonstrate our initial experience with and the feasibility of
laparoendoscopic single-site retroperitoneoscopic adrenalectomy (LESS-RA). Patients and Methods: 54
patients undergoing conventional retroperitoneoscopic adrenalectomy were compared with 27 patients
undergoing LESS-RA. The adrenal tumors were considered to be benign preoperatively and <6 cm. Age,
sex, laterality, body mass index, surgical indications, time to resuming oral intake, tumor size, operation
time, estimated blood loss, intravenous or intramuscular analgesics (pethidine) and postoperative hospital
stay were compared between the two groups. Analysis of covariance was applied to analyze postoperative
hospital stay and time to resuming oral intake. Results: The length of postoperative hospital stay was
significantly higher in the conventional retroperitoneoscopic adrenalectomy group in the adjusted and
unadjusted model. The time to resuming oral intake was significant shorter in the LESS-RA group, but was
not significant after adjusting opioid analgesics dosage. No conversions to an open or conventional
retroperitoneoscopic approach were necessary. There were neither complications nor blood transfusions in
both groups. Conclusions: LESS-RA for benign adrenal tumors is a feasible surgical procedure when
tumors are <6 cm. Further clinical research is warranted to define the role of LESS inadrenal surgery and
to prove its efficacy over conventional laparoscopic surgery.
Copyright © 2013 S. Karger AG, Basel.
PMID: 24051557
13. Minerva Chir. 2013 Aug;68(4):377-84. IF: 0.49
Laparoscopic Adrenalectomy for Cushing's Syndrome: a 12-year experience.
Romiti C, Baldarelli M, Cappelletti Trombettoni M, Budassi A, Ghiselli R, Guerrieri M.
Source
Clinic of General Surgery and Surgery Methodology, University of Marche-Ospedali Riuniti Ancona, Italy -
Abstract
Aim: The outcome after laparoscopic adrenalectomy in 51 patients with pre-Cushing's and Cushing's
syndrome was evaluated at six months and one year of follow-up. Methods: In this retrospective analysis of
51 patients (35 females and 16 males) selected for laparoscopic adrenalectomy (28 left and 23
right adrenal glands), clinical presentation, endocrine and blood chemistry and hemodynamics, and pre-
and postsurgical management were analyzed. Evaluations included, blood pressure, body-mass index
(BMI), lipid profile, blood glucose (fasting insulin and oral glucose tolerance test [OGTT]), liver function and
hormonal profile (17-hydroxyprogesterone, dehydroepiandrosterone sulfate and cortisol), and perioperative
complications. Results: Follow-up assessment showed a significant reduction in systolic (12.34 mm Hg)
and diastolic blood pressure (11.09 mm Hg), a statistically significant decrease in total (11.67 mg/dL) and a
statistically significant increase in high-density lipoprotein (HDL) cholesterol (6.46 mg/dL), and a statistically
significant decrease in blood glucose at 60 minutes and an increase in insulin at 120 minutes. No
statistically significant changes in the hormone profile were observed. There was a statistically significant
reduction in cortisol concentration in response to the dexamethasone test. Mortality was zero and the
surgical complications rate was low. Conclusion: Laparoscopic adrenalectomy has become the gold
standard in the treatment of adrenal disease. It is a safe technique, with clinically effective results and an
excellent perioperative course.
PMID: 24019045
ADRENAL
VAKA SUNUMU
1. Urology. 2013 Jul;82(1):e3-4. doi: 10.1016/j.urology.2013.04.005. IF: 2.50
Giant adrenal cavernous hemangioma: a rare abdominal mass.
Galea N, Noce V, Ciolina F, Liberali S, Francone M.
Source
Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome,
Italy. [email protected]
Abstract
An 84-year-old woman with left flank pain presented to our institution. Contrast-enhanced computed
tomography demonstrated a large spherical adrenal mass (diameter 13 cm) showing features of a benign
lesion. Histologic examination revealed a giant adrenal hemangioma. Surgical resection was curative, with
no recurrence at 2 years of follow-up. Surgery is usually recommended for symptomatic patients or in the
case of a large lesion (>6 cm) because of the possibility of the coexistence of a malignancy or potential
complications (ie, hemorrhage, rupture).
Copyright © 2013 Elsevier Inc. All rights reserved.
PMID: 23806410
http://dx.doi.org/10.1016/j.urology.2013.04.005
2. J Pediatr Hematol Oncol. 2013 Jul;35(5):e183-6. doi: 10.1097/MPH.0b013e318286d112. IF: 1.13
A rare adolescent case of female pseudohermaphroditism with adrenocortical carcinoma and synchronous teratoma.
He XF, Peng XC, Qiu M.
Source
Cancer Center, Division of Abdominal Cancer, West China Hospital of Sichuan University, Chengdu,
China.
Abstract
A patient with female pseudohermaphroditism is chromosomally and gonadally a female individual but has
male or ambiguous external genitalia. In this paper, we report a 12-year-old Chinese girl who was
diagnosed with female pseudohermaphroditism characterized by clitoridauxe, hirsutism, acne,
hypertension, and karyotype 46 XX. Computed tomography scan revealed a huge left abdominal mass with
distant metastases to bilateral lungs and a concomitant pelvic teratoma. Because the left abdominal mass
was unresectable, the patient underwent a biopsy of the abdominal mass and a radical resection of the
pelvic teratoma. Histopathology confirmed that the left abdominal mass was an adrenocortical carcinoma
(ACC) and the pelvic teratoma was a mature cystic teratoma originating from the left ovary. After surgery,
the patient received a transcatheter arterial chemoembolization of ACC, combined with 2 g mitotane daily
for systemic treatment. It was a pity that she died 8 months later after diagnosis. So far, as we know, the
simultaneous occurrence of pseudohermaphroditism, ACC, and ovarian teratomas has not been reported
in the literatures before.
PMID: 23528907
http://dx.doi.org/10.1097/MPH.0b013e318286d112
NET
DERLEME
1. Lancet. 2013 Sep 14;382(9896):973-83. doi: 10.1016/S0140-6736(13)60106-3. Epub 2013 Apr 24.
IF: 21.78
Gastrointestinal stromal tumour.
Joensuu H, Hohenberger P, Corless CL.
Source
Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland. [email protected]
Abstract
Gastrointestinal stromal tumours (GISTs) are mesenchymal neoplasms that arise in the gastrointestinal
tract, usually in the stomach or the small intestine and rarely elsewhere in the abdomen. They can occur at
any age, the median age being 60-65 years, and typically cause bleeding, anaemia, and pain. GISTs have
variable malignant potential, ranging from small lesions with a benign behaviour to fatal sarcomas. Most
tumours stain positively for the mast/stem cell growth factor receptor KIT and anoctamin 1 and harbour a
kinase-activating mutation in either KIT or PDGFRA. Tumours without such mutations could have
alterations in genes of the succinate dehydrogenase complex or in BRAF, or rarely RAS family genes.
About 60% of patients are cured by surgery. Adjuvant treatment with imatinib is recommended for patients
with a substantial risk of recurrence, if the tumour has an imatinib-sensitive mutation. Tyrosine kinase
inhibitors substantially improve survival in advanced disease, but secondary drug resistance is common.
Copyright © 2013 Elsevier Ltd. All rights reserved.
PMID: 23623056
http://dx.doi.org/10.1016/S0140-6736(13)60106-3
2. J Natl Cancer Inst. 2013 Jul 17;105(14):1005-17. doi: 10.1093/jnci/djt135. Epub 2013 Jul 9. IF:
11.75
Current understanding of the molecular biology of pancreatic neuroendocrine tumors.
Zhang J, Francois R, Iyer R, Seshadri M, Zajac-Kaye M, Hochwald SN.
Source
Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
Abstract
Pancreatic neuroendocrine tumors (PanNETs) are complicated and often deadly neoplasms. A recent
increased understanding of their molecular biology has contributed to expanded treatment options. DNA
sequencing of samples derived from patients with PanNETs and rare genetic syndromes such as multiple
endocrine neoplasia type 1 (MEN1) and Von Hippel-Lindau (VHL) syndrome reveals the involvement of
MEN1, DAXX/ATRX, and the mammalian target of rapamycin (mTOR) pathways in PanNET tumorigenesis.
Gene knock-out/knock-in studies indicate that inactivation of factors including MEN1 and abnormal
PI3K/mTOR signaling uncouples endocrine cell cycle progression from the control of environmental cues
such as glucose, leading to islet cell overgrowth. In addition, accumulating evidence suggests that further
impairment of endothelial-endocrine cell interactions contributes to tumor invasion and metastasis. Recent
phase III clinical trials have shown that therapeutic interventions, such as sunitinib and everolimus,
targeting those signal transduction pathways improve disease-free survival rates. Yet, cure in the setting of
advanced disease remains elusive. Further advances in our understanding of the molecular mechanisms of
PanNETs and improved preclinical models will assist in developing personalized therapy utilizing novel
drugs to provide prolonged control or even cure the disease.
PMID: 23840053
http://dx.doi.org/10.1093/jnci/djt135
3. Cancer Lett. 2013 Jul 10;335(1):1-8. doi: 10.1016/j.canlet.2013.02.016. Epub 2013 Feb 16. IF: 4.47
PI3K/Akt/mTOR pathway inhibitors in the therapy of pancreatic neuroendocrine tumors.
Wolin EM.
Source
Division of Hematology/Oncology, Samuel Oschin Cancer Center, Cedars-Sinai Medical Center, 8700
Beverly Blvd., Los Angeles, CA 90048, USA. [email protected]
Abstract
The phosphatidylinositol 3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) pathway is
implicated in the pathogenesis of pancreatic neuroendocrine tumors (pNETs). Activation of this pathway is
driven by aberrant tyrosine kinase receptor activities. Mutations in the PI3K/Akt/mTOR pathway occur in
15% of pNETs, and expression of genes of the PI3K/Akt/mTOR pathway is altered in the majority of
pNETs. The mTOR inhibitor everolimus has been approved by the FDA for the treatment of pNET, but its
efficacy may be limited by its inability to prevent mTORC2-mediated activation of Akt. Specific inhibitors of
PI3K, Akt, or other pathway nodes, and their concomitant use with mTOR inhibitors, or agents with dual
activity, may be more effective. Preclinical studies demonstrate that inhibitors of the PI3K pathway have
antitumor activity in pNET cells, either through direct inhibition of individual pathway nodes or indirect
inhibition of molecular chaperones such as heat-shock protein 90. Clinical studies are underway evaluating
individual node and dual node inhibitors.
Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
PMID: 23419523
http://dx.doi.org/10.1016/j.canlet.2013.02.016
4. Mol Cell Endocrinol. 2013 Jul 30. pii: S0303-7207(13)00309-2. doi: 10.1016/j.mce.2013.07.015.
[Epub ahead of print] IF: 4.17
Gastroenteropancreatic endocrine tumors.
Meeker A, Heaphy C.
Source
The Johns Hopkins University School of Medicine, Department of Pathology, Bond Street Research Annex
Bldg., Room B300, 411 North Caroline Street, Baltimore, MD 21231, United States. Electronic address:
Abstract
Gastroenteropancreatic endocrine tumors (GEP-NETs) are relatively uncommon; comprising approximately
0.5% of all human cancers. Although they often exhibit relatively indolent clinical courses, GEP-NETs have
the potential for lethal progression. Due to their scarcity and various technical challenges, GEP-NETs have
been understudied. As a consequence, we have few diagnostic, prognostic and predictive biomarkers for
these tumors. Early detection and surgical removal is currently the only reliable curative treatment for GEP-
NET patients; many of whom, unfortunately, present with advanced disease. Here, we review the genetics
and epigenetics of GEP-NETs. The last few years have witnessed unprecedented technological advances
in these fields, and their application to GEP-NETS has already led to important new information on the
molecular abnormalities underlying them. As outlined here, we expect that "omics" studies will provide us
with new diagnostic and prognostic biomarkers, inform the development of improved pre-clinical models,
and identify novel therapeutic targets for GEP-NET patients.
Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
KEYWORDS:
ATRX, Carcinoid, DAXX, Epigenomics, Gastroenteropancreatic Neuroendocrine Tumor, Genomics
PMID: 23906538
http://dx.doi.org/10.1016/j.mce.2013.07.015
5. Expert Rev Gastroenterol Hepatol. 2013 Jul;7(5):477-90. doi: 10.1586/17474124.2013.811058.
IF: 2.44
Advancements in pancreatic neuroendocrine tumors.
Sadaria MR, Hruban RH, Edil BH.
Source
Department of Surgery, University of Colorado Anschutz Medical Campus, Division of GI, Tumor and
Endocrine Surgery, Academic Office One, 12631 East 17th Avenue, C311, Aurora, CO 80045, USA.
Abstract
Pancreatic neuroendocrine tumors (PanNETs) have increased in incidence in the USA over the last 20
years. Although PanNETs are often misconceived as being indolent tumors as they have a far more
favorable prognosis over pancreatic adenocarcinoma, roughly 60-70% of patients have metastatic disease
at the time of diagnosis due to presentation late in the disease process. While improvements in imaging
modalities allow for early detection and better tumor localization, recent advancements in basic science, as
well as surgical and medical management of PanNETs have further improved the prognosis. The mainstay
of therapy for localized PanNETs is surgical intervention, which has become safer and is slowly shifting
towards a more minimally invasive approach. However, the prognosis still remains relatively bleak for
patients with unresectable disease. Fortunately, novel molecular targeted therapies, such as everolimus
and sunitinib, have recently come into the limelight and have shown significant promise for the treatment of
locally advanced and metastatic disease.
PMID: 23899286
http://dx.doi.org/10.1586/17474124.2013.811058
6. Endocr Pract. 2013 Sep 6:1-30. [Epub ahead of print] IF: 2.12
Systemic Treatment of Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs): Current Approaches and Future Options.
Strosberg JR.
Source
H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
Abstract
Objective: To describe recent advances in treatment of gastroenteropancreatic neuroendocrine
tumors (GEP-NETs).Methods: A review of the published English language literature on therapy of GEP-
NETs with a focus on practice-changing clinical trials.Results: Somatostatin analog treatment remains a
cornerstone of GEP-NET therapy, primarily for patients with hormonally functional tumors and midgut
carcinoids. The biologic agents everolimus and sunitinib have similar tumor-stabilizing effects in pancreatic
NETs and are both approved for treatment of progressive low-intermediate grade tumors. Their role in non-
pancreatic NETs remains controversial. Cytotoxic chemotherapy has significant activity in pancreatic NETs
but modern prospective data is lacking. Radiolabeled somatostatin analogs will likely become more widely
available once phase III randomized studies are completed.Conclusions: New treatment options for GEP-
NETs have become available, and highlight the necessity of developing predictive biomarkers which will
allow for appropriate and individualized selection of therapy.
PMID: 24014009
NET
PROSPEKTİF
1. Cancer Chemother Pharmacol. 2013 Aug;72(2):387-95. doi: 10.1007/s00280-013-2202-1. Epub
2013 Jun 14. IF: 2.97
Safety, tolerability, pharmacokinetics, and pharmacodynamics of a long-acting release (LAR) formulation of pasireotide (SOM230) in patients with gastroenteropancreatic neuroendocrine tumors: results from a randomized, multicenter, open-label, phase I study.
Wolin EM, Hu K, Hughes G, Bouillaud E, Giannone V, Resendiz KH.
Source
Carcinoid/Neuroendocrine Tumor Program, Samuel Oschin Cancer Center, Cedars-Sinai Medical Center,
8700 Beverly Boulevard, Los Angeles, CA 90048, USA. [email protected]
Abstract
PURPOSE:
Pasireotide (SOM230), a novel multireceptor ligand somatostatin analog (SSA), binds with high affinity to
four of the five somatostatin receptor subtypes (sst1-3, 5). This study evaluated the safety, tolerability,
pharmacokinetics, and pharmacodynamics profiles of pasireotide long-acting release (LAR) formulation in
patients with advanced gastroenteropancreatic neuroendocrine tumor (GEP NET) refractory to other SSAs.
METHODS:
In this randomized, multicenter, open-label, phase II study, patients with biopsy-proven primary or
metastatic GEP NET refractory to available SSAs were randomly assigned 1:1:1 to receive pasireotide LAR
by deep intragluteal injection at a dose of 20, 40, or 60 mg once every 28 days for 3 months.
RESULTS:
Forty-two patients received pasireotide LAR. Adverse events were reported by 34 (81 %) patients, with the
most frequently reported including diarrhea, fatigue, abdominal pain, and nausea. Mean fasting glucose
levels were increased compared with baseline at all points throughout the study. After the third injection of
pasireotide LAR, the median trough plasma concentrations on day 84 were 4.82, 12.0, and 19.7 ng/mL in
the 20-, 40-, and 60-mg treatment groups, respectively. Drug accumulation was limited for each dose
based on the increase in trough concentrations after the first to third injections (accumulation ratios were
approximately 1 from all dose levels).
CONCLUSIONS:
This study demonstrated that a new, once-monthly, intramuscular LAR formulation of pasireotide was well
tolerated in patients with advanced GEP NET. Steady state levels of plasma pasireotide were achieved
after three injections.
PMID: 23765178
http://dx.doi.org/10.1007/s00280-013-2202-1
NET
RETROSPEKTİF
1. J Clin Oncol. 2013 Sep 16. [Epub ahead of print] IF: 15.18
Revised Staging Classification Improves Outcome Prediction for Small Intestinal Neuroendocrine Tumors.
Kim MK, Warner RR, Roayaie S, Harpaz N, Ward SC, Itzkowitz S, Wisnivesky JP.
Source
Mount Sinai School of Medicine, New York, NY.
Abstract
PURPOSE:
Small intestinal (SI) neuroendocrine tumors (NETs) have heterogeneous outcomes. The NET societies
have recently proposed a TNM staging classification. In this study, we used population-based data to
assess the validity of the staging system.
PATIENTS AND METHODS:
We identified patients with SI-NETS diagnosed between 1988 and 2009 from the Surveillance,
Epidemiology, and End Results registry. We used Kaplan-Meier analysis to assess disease-specific
survival according to TNM status. Cox models were constructed to evaluate differences in prognosis after
controlling for potential confounders.
RESULTS:
We identified 6,792 patients with SI-NET. Although the current staging system was predictive of prognosis,
there was overlap among some groups (stage I/IIA, P = .36; stage IIB/IIIB, P = .70). Additionally, stage IIIB
patients had better survival than stage IIIA patients (P < .001). Adjusted analyses showed similar outcomes
for T1 versus T2 disease (hazard ratio [HR], 1.02; 95% CI, 0.63 to 1.66). Patients with T3 (HR, 3.60; 95%
CI, 2.28 to 5.69) and T4 (HR, 5.50; 95% CI, 3.42 to 8.86) tumors had significantly worse survival than
patients with T1 disease. N1 involvement conferred worse survival in T1 (HR, 3.08; 95% CI, 1.75 to 5.44)
and T2 disease (HR, 2.73; 95% CI, 1.84 to 4.07) but not in T3 (HR, 0.99; 95% CI, 0.76 to 1.30) or T4 (HR,
0.98; 95% CI, 0.71 to 1.35) disease. A revised classification showed no overlap in survival across groups.
CONCLUSION:
Progressively more advanced T status is associated with worse SI-NET prognosis. Regional lymph node
involvement is a marker of worse survival only among patients with T1 or T2 status. These results suggest
that revisions to the current staging classification may be helpful.
PMID: 24043726
2. Ann Oncol. 2013 Sep 19. [Epub ahead of print] IF: 7.05
Gastrointestinal carcinoid: epidemiological and survival evidence from a large population-based study (n = 25 531).
Mocellin S, Nitti D.
Source
Department of Surgery Oncology and Gastroenterology, School of Medicine, University of Padova, Padova,
Italy.
Abstract
BACKGROUND:
Owing to its rarity, the published evidence on gastrointestinal (GI) carcinoid is often based on small series
of patients or population-based studies regarding all neuroendocrine tumors. Here, we present a
comprehensive epidemiological and survival analysis of the largest cohort of patients with GI carcinoid ever
reported.
PATIENTS AND METHODS:
Patients with histological diagnosis of GI carcinoid (n = 25 531) were identified from the Surveillance
Epidemiology End Results (SEER) database (including 18 USA cancer registries and spanning the 1973-
2009 time frame). Demographic and disease data were used for
RESULTS:
The incidence of GI carcinoid is steadily increasing over the past three decades at a rate higher than any
other cancer [annual percentage change (APC) = 4.4, 95% confidence interval (CI) 4.0-4.8]. These patients
have a higher risk of further primary tumor (standardized incidence ratio, SIR = 1.15, 95% CI 1.10-1.21),
but also a reduced risk of skin melanoma (SIR = 0.64, 95% CI 0.41-0.95). Despite the overall favorable
prognosis (5-year disease-specific and relative survival rate: 91.3% and 87.4%, respectively), the mortality
rate is increasing over time (APC = 3.5, 95% CI 3.0-4.0) and the 5-year survival rate of patients dying of GI
carcinoid (28.5%), though better than that reported for GI cancers in general (8.4%), cannot be considered
satisfactory. Finally, a nomogram is provided to predict patient survival on the basis of clinico-pathological
factors independently associated with prognosis at multivariate analysis.
CONCLUSIONS:
These findings can be clinically useful for the management of patients with GI carcinoid and eagerly prompt
the continuous effort to develop more effective therapeutic strategies against this slow-growing but
chemoresistant tumor.
KEYWORDS:
SEER, carcinoid, epidemiology, gastrointestinal, population-based study, survival analysis
PMID: 24050954
3. Radiology. 2013 Aug;268(2):390-9. doi: 10.1148/radiol.13121628. Epub 2013 Mar 26. IF: 6.40
High sensitivity of diffusion-weighted MR imaging for the detection of liver metastases from neuroendocrine tumors: comparison with T2-weighted and dynamic gadolinium-enhanced MR imaging.
d'Assignies G, Fina P, Bruno O, Vullierme MP, Tubach F, Paradis V, Sauvanet A, Ruszniewski
P, Vilgrain V.
Source
Department of Radiology, Assistance-Publique Hôpitaux de Paris, Hôpital Beaujon, 100 bd du Général
Leclerc, 92110 Clichy, France.
Abstract
PURPOSE:
To compare the sensitivity and specificity of diffusion-weighted (DW) magnetic resonance (MR) imaging for
identifying liver metastases from neuroendocrine tumor (NET) to those of T2-weighted fast spin-echo (FSE)
and three-dimensional dynamic gadolinium-enhanced MR imaging, with surgical and histopathologic
findings as the reference standard.
MATERIALS AND METHODS:
This retrospective study was approved by institutional review board, and informed consent was waived.
Fifty-nine patients with NETs (41 patients with 162 liver metastases, and 18 control subjects with no liver
metastases) underwent MR imaging that included DW, T2-weighted FSE, and dynamic gadolinium-
enhanced MR sequences. Images were retrospectively reviewed by two abdominal radiologists,
independently, for the detection and characterization of liver metastases. MR findings were compared with
histopathologic and intraoperative ultrasonography findings for metastasis on a lesion-by-lesion basis to
determine the sensitivity of each MR sequence alone and combined. Specificity was calculated by using
the control population. Interreader agreement for each MR sequence and McNemar test were also
calculated.
RESULTS:
There was excellent agreement between observers 1 and 2 for characterizing liver metastases at per-
lesion analysis (κ coefficient: 0.86-1.00). DW MR was more sensitive (observer 1: sensitivity, 71.6% [116 of
162], 95% confidence interval [CI]: 64.2%, 78.0%; observer 2: sensitivity, 71.0% [115 of 162], 95% CI:
63.6%, 77.4%) than T2-weighted FSE (observer 1: sensitivity, 55.6% [90 of 162], 95% CI: 47.9%, 63.0%;
observer 2: sensitivity, 55.6% [90 of 162], 95% CI: 47.9%, 63.0%) and dynamic gadolinium-enhanced MR
(observer 1: sensitivity, 47.5% [77 of 162], 95% CI: 34.0%, 55.2%; observer 2: sensitivity, 48.1% [78 of
162], 95% CI: 40.6%, 55.8%) (P < .001 for both, McNemar test). The specificity of these sequences ranged
from 88.9% to 100% (DW MR vs T2-weighted FSE MR: P > .99, DW MR vs dynamic gadolinium-enhanced
MR: P = .61, and T2-weighted FSE MR vs dynamic gadolinium-enhanced MR: P = .61, McNemar test).
CONCLUSION:
DW MR imaging was more sensitive for the detection and characterization of liver metastases from NETs
than T2-weighted FSE and dynamic gadolinium-enhanced MR imaging and should be systematically
performed.
PMID: 23533288
http://dx.doi.org/10.1148/radiol.13121628
4. Cancer. 2013 Sep 10. doi: 10.1002/cncr.28341. [Epub ahead of print] IF: 5.54
Clinicopathologic characteristics of pancreatic neuroendocrine tumors and relation of somatostatin receptor type 2A to outcomes.
Okuwaki K, Kida M, Mikami T, Yamauchi H, Imaizumi H, Miyazawa S, Iwai T, Takezawa M, Saegusa M, Watanabe M, Koizumi W.
Source
Department of Gastroenterology, Kitasato University East Hospital, Kanagawa, Japan.
Abstract
BACKGROUND:
The impact of somatostatin receptor type 2 (SSTR-2a) expression levels on outcomes in patients with
pancreatic neuroendocrine tumors (PNETs) has not been evaluated.
METHODS:
Correlations between clinicopathologic characteristics, including SSTR-2a expression and outcomes, were
retrospectively studied in 79 patients with pancreatic neuroendocrine tumors (PNETs).
RESULTS:
The SSTR-2a score was 0 in 27% of patients, 1 in 24% of patients, 3 in 30% of patients, and 4 in 18% of
patients. The overall survival rate was 87% at 1 year, 77% at 3 years, and 71% at 5 years. On univariate
analysis, a pancreatic tumor that measured ≥20 mm in greatest dimension, stage IV disease, vascular
invasion, neuroendocrine carcinoma (NEC), and an SSTR-2a score of 0 were associated significantly with
poor outcomes. On multivariate analysis, NEC (P = .000; hazard ratio, 28.8; 95% confidence interval,
7.502-111.240) and an SSTR-2a score of 0 (P = .001; hazard ratio, 3.611; 95% confidence interval, 1.344-
9.702) were related independently to poor outcomes.
CONCLUSIONS:
The current analysis of prognostic factors in patients with PNETs demonstrated that NEC and an SSTR-2a
score of 0 both were significant independent predictors of poor outcomes. The results suggest that the
assessment of SSTR-2a may facilitate the selection of treatment regimens and the prediction of outcomes.
Because a considerable proportion of patients with NEC have SSTR-2a-positive tumors, further analyses of
the usefulness of somatostatin analogues are warranted in patients who have SSTR-2a-positive NEC.
Cancer 2013. © 2013 American Cancer Society.
© 2013 American Cancer Society.
KEYWORDS:
2010 World Health Organization classification, SSTR-2a, neuroendocrine tumor, pancreatic neuroendocrine tumors, somatostatin receptor type 2A
PMID: 24022344
http://dx.doi.org/10.1002/cncr.28341
5. Am J Surg Pathol. 2013 Jul;37(7):949-59. doi: 10.1097/PAS.0b013e31828ff59d. IF: 5.53
Neuroendocrine carcinoma of the stomach: morphologic and immunohistochemical characteristics and prognosis.
Ishida M, Sekine S, Fukagawa T, Ohashi M, Morita S, Taniguchi H, Katai H, Tsuda H, Kushima
R.
Source
Gastric Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
Abstract
Neuroendocrine carcinoma (NEC) of the stomach has been recognized as a highly malignant tumor;
however, because of its rarity, limited information is available regarding its clinicopathologic characteristics.
Here, we investigated the morphologic and immunohistochemical features and prognosis of 51 cases of
gastric NEC. Histologically, 40 lesions were large cell type, and 11 were small cell type. The large majority
of the tumors exhibited a solid growth pattern (94%), with subsets of tumors showing trabecular (18%),
scirrhous (10%), or tubular growth patterns (6%). Thirty-six cases (71%) had adenocarcinoma components
and/or dysplasia. Among them, 26 cases (51%) were associated with intramucosal adenocarcinoma or
dysplasia. Immunohistochemically, synaptophysin, chromogranin A, and CD56 were diffusely expressed in
48 (94%), 44 (86%), and 24 cases (47%), respectively. Two recently reported neuroendocrine markers,
ASH1 and NKX2.2, were diffusely positive in 12 (24%) and 17 cases (33%), respectively. The diffuse or
focal expression of TTF-1 was observed in 19 cases (37%). Among the 41 patients who underwent a
curative resection, 16 patients (39%) developed radiologic recurrences, and the liver was the most frequent
site of recurrence (11 patients, 27%). The 3- and 5-year overall survival rates were 57.8% and 44.7%,
respectively. Regarding patient outcome, none of the histologic subclassifications, including small cell
versus large cell types and the presence versus the absence of adenocarcinoma components and/or
dysplasia, were significant. In a multivariate analysis, curative surgery was identified as the sole
independent prognostic factor (P=0.03). Although gastric NECs exhibit significant morphologic diversity,
their histologic subclassification is unlikely to be of immediate clinical relevance.
PMID: 23759931
http://dx.doi.org/10.1097/PAS.0b013e31828ff59d
6. Eur J Cancer. 2013 Aug;49(12):2681-8. doi: 10.1016/j.ejca.2013.04.006. Epub 2013 May 8. IF:
5.53
Clinical significance of surgery for gastric submucosal tumours with size enlargement during watchful waiting period.
Miyazaki Y, Nakajima K, Kurokawa Y, Takahashi T, Takiguchi S, Miyata H, Yamasaki M, Hirota
S, Nishida T, Mori M, Doki Y.
Source
Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka
University, Osaka, Japan.
Abstract
BACKGROUND:
The true impact of surgery for small, asymptomatic and biopsy-negative gastric submucosal tumours
(SMTs) with size enlargement during 'watchful waiting' period has not been fully understood.
METHODS:
From 2005 to 2012, 100 patients with gastric SMTs underwent surgery. Twenty-three of them with size
enlargement during observation period were enrolled in the retrospective analysis. Data included
clinicopathologic findings, genetic findings, operative outcomes and prognoses.
RESULTS:
All patients (13 males, 10 females), with median age of 54 (41-71), had their lesions detected by routine
health check-up (n=21) or incidentally (2). The tumours were 1.8 (0.5-4.0)cm in size at their initial detection,
and enlarged up to 3.2 (2.0-7.0)cm at the operation during 63.0 (14.6-233.7) months. As surgical
procedure, laparoscopic partial gastrectomy accounted for the majority (78.3%). Histologic examination
revealed gastrointestinal stromal tumour (GIST) (21) and schwannoma (2). Although 16 out of 21 GISTs
were categorised into 'Very low' (1), and 'Low' (13) risk according to Fletcher's classification, 'Intermediate'
(5) and 'High' (2) risk were identified in the series. No recurrences/metastases were noted in 23.2 (0.9-87)
months of postoperative follow-up.
CONCLUSION:
Our study revealed the existence of high mitotic GISTs in asymptomatic, small gastric SMTs with size
enlargement, and laparoscopic surgery was safely applied to majority of those cases. Prompt surgical
intervention should therefore be considered for those lesions.
Copyright © 2013 Elsevier Ltd. All rights reserved.
KEYWORDS:
GIST, Gastrointestinal stromal tumour, Guidelines, Incidental GIST, Laparoscopic surgery, Mitosis, NCCN, Risk stratification, Submucosal tumour
PMID: 23664093
http://dx.doi.org/10.1016/j.ejca.2013.04.006
7. Neuroendocrinology. 2013 Sep 21. [Epub ahead of print] IF: 3.86
Clinical and Prognostic Features of Rectal Neuroendocrine Tumors.
Weinstock B, Ward SC, Harpaz N, Warner RR, Itzkowitz S, Kim MK.
Source
Division of Gastroenterology, Departments of Medicine, Mount Sinai School of Medicine, New York, N.Y.,
USA.
Abstract
Background: Rectal neuroendocrine tumors (NETs) are among the most common neuroendocrine tumors.
The aim was to validate ENETS/NANETS staging and grading systems with regard to clinical outcomes.
Methods: A comprehensive database was constructed from existing databases of The Mount Sinai Division
of Gastrointestinal Pathology and the Carcinoid Cancer Foundation. Analysis was performed on 141
patients identified with rectal NETs seen at The Mount Sinai Hospital between 1972 and 2011. Results:
The median age was 52.7 years; 43% were males. Average tumor size was 0.88 cm. NETs less than 1 cm
accounted for 75.6% of the tumors. Stage I, II, III and IV tumors accounted for 79.4, 2.8, 5.0 and 12.8%,
respectively. G1 tumors accounted for 88.1%, G2 8.3% and G3 3.6%. Of G1 tumors, 94.6% were stage I
and 5.4% were Stage IV. The median survival time for all 141 patients was 6.8 years (range, 0.8-34.7
years). The overall 5-year survival rate was 84.4%. The 5-year survival rates for patients in stage I-IV were
92.7, 75.0, 42.9 and 33.2%, respectively. The 5-year survival rates for patients with G1-G3 tumors were
87.7, 47.6 and 33.3% respectively. Univariate analysis of increased survival showed significance for lower
stage, lower grade, smaller size, absence of symptoms and endoscopically treatedtumors. Multivariate
analysis showed that stage alone was statistically significant as the strongest predictor of survival.
Conclusion: The results of our study validated ENETS/NANETS guidelines for staging and grading of
rectal neuroendocrine tumors in the U.S. setting of a tertiary referral center. Staging according to
ENETS/NANETS guidelines should be used in the treatment algorithm rather than size alone. © 2013 S.
Karger AG, Basel.
PMID: 24080744
8. Am J Clin Pathol. 2013 Jul;140(1):61-72. doi: 10.1309/AJCPIV40ISTBXRAX. IF: 3.22
Epithelial-mesenchymal transition markers in the differential diagnosis of gastroenteropancreatic neuroendocrine tumors.
Galván JA, Astudillo A, Vallina A, Fonseca PJ, Gómez-Izquierdo L, García-Carbonero
R, González MV.
Source
Laboratorio del Banco de Tumores-Anatomia Patológica, c/ Celestino Villamil, s/n, 33006 Oviedo, Spain.
Abstract
OBJECTIVES:
To elucidate the role of epithelial-mesenchymal transition markers in gastroenteropancreatic
neuroendocrine tumors (GEP NETs) and the potential usefulness in their clinical management.
METHODS:
One hundred ten GEP NET paraffin-embedded samples were immunohistochemically analyzed for E-
cadherin, N-cadherin, β-catenin, vimentin, Snail1, Snail2, Twist, and Foxc2 protein expression.
RESULTS:
The 5-year survival rate was reduced for those patients showing high Snail1 protein levels, a cytoplasmic
E-cadherin pattern, reduced N-cadherin expression, and loss of E-cadherin/β-catenin adhesion complex
integrity at the cell membrane. Interestingly, high β-catenin expression was useful in identifying a grade 1
NET subgroup with a favorable clinical course. Importantly, it also helped to discriminate small-cell vs
large-cell grade 3 neuroendocrine carcinomas.
CONCLUSIONS:
β-Catenin and N-cadherin immunohistochemical detection might be a useful tool in the differential
diagnosis of small-cell vs large-cell G3 neuroendocrine carcinomas. High Snail1 and Foxc2 expression is
associated with the invasion and metastatic spread of GEP NETs.
KEYWORDS:
E-cadherin, EMT, Foxc2, Neuroendocrine tumors, Snail1, Snail2, β-catenin
PMID: 23765535
http://dx.doi.org/10.1309/AJCPIV40ISTBXRAX
9. J Surg Oncol. 2013 Aug;108(2):126-8. doi: 10.1002/jso.23359. Epub 2013 Jun 15. IF: 2.97
Serum pancreastatin: the next predictive neuroendocrine tumor marker.
Rustagi S, Warner RR, Divino CM.
Source
Department of Surgery, The Mount Sinai Hospital New York, New York, NY 10029, USA.
Abstract
BACKGROUND AND OBJECTIVES:
Pancreastatin is a derived peptide of chromogranin A (CgA). Pancreastatin has the potential to be a
diagnostic and predictive tumor marker in detecting NETs.
METHODS:
Radioimmunoassay tests of pancreastatin and CgA were performed on 103 patient specimens collected at
Mount Sinai Medical Center between 1/2010 and 7/2012. Patient demographics, diagnostic tests, surgical
procedures, pathologic findings, adjuvant treatments, and survival were retrospectively reviewed. Statistical
analysis utilized SPSS v20 software.
RESULTS:
Mean pancreastatin levels were significantly higher in the 92 NETs patients than in the 11 non-NETs
patients (227.261 vs. 59.727, P < 0.05). Twenty-seven of the 92 patients with elevated pancreastatin levels
(mean = 240.67), had normal CgA levels (mean = 4.65). Pancreastatin had sensitivity and specificity of 64%
(59/92), and 100% (11/11). CgA had lower sensitivity and specificity of 43% (40/92), and 64% (7/11). In all
27 instances the pancreastatin concentration was found to be sole indicator of NET disease. When
controlling for the level of CgA for the entire sample, a statistically significant difference was not found in
the mean pancreastatin levels between both patient groups (P = 0.139, R = 0.484).
CONCLUSION:
Pancreastatin has greater sensitivity and specificity in diagnosing NETs than CgA. Further investigation of
pancreastatin's diagnostic and predictive value is warranted.
Copyright © 2013 Wiley Periodicals, Inc.
KEYWORDS:
CgA, NETs, pancreastatin
PMID: 23775817
http://dx.doi.org/10.1002/jso.23359
10. Dig Dis Sci. 2013 Jul;58(7):2093-9. doi: 10.1007/s10620-013-2590-4. Epub 2013 Feb 20. IF: 2.65
Factors predictive of adverse events associated with endoscopic ultrasound-guided fine needle aspiration of pancreatic solid lesions.
Katanuma A, Maguchi H, Yane K, Hashigo S, Kin T, Kaneko M, Kato S, Kato R, Harada
R, Osanai M, Takahashi K, Nojima M.
Source
Center for Gastroenterology, Teine-Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, Hokkaido 006-
8555, Japan. [email protected]
Abstract
BACKGROUND:
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) provides high diagnostic accuracy with a
low incidence of procedural complications. However, it occasionally causes serious complications, and
factors that increase the susceptibility to such adverse events remain unknown.
AIMS:
We aimed to examine post-procedural events and determine risk factors associated with EUS-FNA of
pancreatic solid lesions.
METHODS:
This single-center retrospective study included 316 consecutive patients with pancreatic solid lesions who
underwent 327 EUS-FNA procedures from April 2003 to September 2011. We registered all patients
undergoing EUS-FNA in the database and retrospectively ascertained the presence/absence of post-
procedural adverse events.
RESULTS:
The incidence of post-procedural adverse events, including moderate to mild pancreatitis, mild abdominal
pain, and mild bleeding, was 3.4 %. Univariate analysis showed that the incidence of post-procedural
events was significantly increased in patients with tumors less than or equal to 20 mm in diameter (P <
0.001), those with pancreatic neuroendocrine tumors (PNET) (P = 0.012), and patients who had intervening
normal pancreas for accessing the lesion (P = 0.048). Multivariate analysis identified tumors measuring
less than or equal to 20 mm in diameter (OR 18.48; 95 % CI 3.55-96.17) and case of PNETs (OR 36.50; 95
% CI 1.73-771.83) were an independent risk factors.
CONCLUSIONS:
EUS-FNA of pancreatic solid lesions is a safe procedure. However, pancreatic lesions with small diameters
and pancreatic neuroendocrine tumors are important factors associated with adverse events after EUS-
FNA.
PMID: 23423501
http://dx.doi.org/10.1007/s10620-013-2590-4
11. Laryngoscope. 2013 Jul;123(7):1645-51. doi: 10.1002/lary.23856. Epub 2013
Jun 4. IF: 1.32
Short-term outcomes and cost of care of treatment of head and neck paragangliomas.
Chan JY, Li RJ, Gourin CG.
Source
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland,
USA.
Abstract
OBJECTIVES/HYPOTHESIS:
To characterize contemporary treatment of head and neck paragangliomas and the effect of treatment on
postoperative complications, length of stay, and costs.
STUDY DESIGN:
Retrospective cross-sectional study.
METHODS:
Discharge data from the Nationwide Inpatient Sample for 7,791 patients who underwent endovascular or
surgical treatment of head and neck paragangliomas between 1993 and 2008 were analyzed using cross
tabulations and multivariate regression modeling.
RESULTS:
Surgery only was performed in 91% of cases, embolization alone was performed in 4% of cases, and both
embolization and surgery were performed in 5% of cases. Postoperative surgical complications were
significantly more likely in patients undergoing embolization and surgery during the same admission (odds
ratio [OR], 2.3; P = .031), whereas acute medical complications were more likely in patients undergoing
embolization only (OR, 3.9; P = .001). Embolization alone was specifically associated with an increased
risk of acute renal failure (OR, 8.2; P = .026) and pneumonia (OR, 3.9; P = .001). Cranial nerve injury was
associated with increased odds of dysphagia (OR, 8.5; P = .004), and dysphagia was associated with
increased odds of voice disturbance (OR, 5.1; P = .004). Embolization, with or without surgery during the
same admission, was associated with significantly increased hospital-related costs, after controlling for all
other variables.
CONCLUSIONS:
Endovascular treatment of head and neck paragangliomas is associated with an increase in complications
and hospital-related costs. Although these findings may reflect larger tumor size and comorbidity in patients
selected for embolization, these data suggest a need to reexamine the benefits and cost-effectiveness of
embolization in surgical patients.
© 2013 The American Laryngological, Rhinological and Otological Society, Inc.
PMID: 23737361
http://dx.doi.org/10.1002/lary.23856